How much does Medicare pay for CPT 91010?

Medicare allowed an average of $95.29 per service and paid $73.29 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $447.94, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 91010?

Study of esophagus to assess movement. It was billed 17,412 times to 17,213 Medicare beneficiaries by 586 providers in 2024.

Does 91010 pay differently in an office than a hospital?

Yes. The allowed amount averaged $173.53 in an office setting and $63.23 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 91010 most?

Gastroenterology, with 14,136 services from 471 clinicians. Next are General Surgery, Internal Medicine, Nurse Practitioner.

CPT 91010

Study of esophagus to assess movement

$95.29Medicare-allowed amount per service, averaged across 17,412 services

Providers submitted

$447.94

Asking price, not received

Medicare allowed

$95.29

The fee schedule figure

Medicare paid

$73.29

Balance is patient coinsurance

Providers submitted an average of $447.94 for this code and Medicare allowed $95.29 — 4.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $73.29 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $173.53
Hospital / facility: $63.23

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 5,061 services were billed in an office setting and 12,351 in a facility.

Services: 17,412
Beneficiaries: 17,213
Providers billing it: 586
Total allowed: $1,659,189

What Medicare pays for CPT 91010

Across 17,412 services billed by 586 providers to 17,213 beneficiaries, Medicare allowed an average of $95.29 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 91010

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	14,136	13,970	$91.49	471
General Surgery	1,407	1,398	$109.24	54
Internal Medicine	839	837	$100.34	26
Nurse Practitioner	365	363	$83.22	11
Otolaryngology	153	148	$205.91	3
Physician Assistant	135	134	$105.14	8
Neurology	103	92	$216.30	1
Thoracic Surgery	100	100	$114.46	5
Cardiac Surgery	50	48	$61.87	1
Pediatric Medicine	46	45	$65.15	3
Radiation Oncology	35	35	$68.79	1
Family Practice	26	26	$211.32	1
Hospitalist	17	17	$249.58	1

91010 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	1,974	$97.03	$66.22	61
Texas	1,286	$100.49	$78.93	46
Florida	1,218	$103.43	$81.05	41
New York	995	$146.30	$101.00	33
Pennsylvania	921	$99.69	$77.34	30
Ohio	816	$83.80	$67.36	22
Illinois	779	$82.29	$61.81	27
Massachusetts	642	$85.88	$61.38	20
North Carolina	592	$90.94	$73.45	18
Arizona	577	$67.48	$52.00	11
Maryland	499	$118.57	$86.89	16
Washington	499	$112.75	$79.99	17
Missouri	493	$60.13	$47.95	11
Georgia	457	$81.81	$62.70	17
Virginia	413	$68.65	$49.52	16
Indiana	309	$80.47	$63.03	15
Colorado	305	$174.93	$127.70	11
South Carolina	292	$102.60	$83.09	12
Oregon	281	$133.81	$100.24	12
New Hampshire	281	$62.41	$47.38	3
Wisconsin	271	$81.46	$64.91	15
Minnesota	251	$149.25	$116.93	10
Tennessee	244	$73.29	$59.93	8
Mississippi	233	$76.87	$61.32	6
Nebraska	214	$108.58	$88.61	7
Oklahoma	201	$102.54	$86.01	5
Alabama	190	$58.48	$47.69	5
Iowa	178	$78.29	$66.08	7
Louisiana	178	$81.83	$66.62	8
Kansas	167	$81.49	$67.57	8
Michigan	163	$61.82	$47.46	2
Kentucky	161	$108.43	$91.37	7
Connecticut	155	$63.87	$47.54	8
Utah	132	$60.84	$44.45	7
New Jersey	125	$69.31	$49.87	5
Montana	123	$61.84	$47.55	3
Arkansas	109	$114.86	$98.35	7
New Mexico	107	$64.38	$46.61	3
South Dakota	98	$60.42	$46.89	5
Nevada	86	$114.48	$86.89	4
District of Columbia	77	$72.53	$47.38	2
Rhode Island	62	$63.52	$48.64	2
Delaware	56	$61.36	$48.34	3
West Virginia	47	$62.48	$49.67	2
Vermont	44	$59.77	$46.16	1
Hawaii	31	$62.75	$49.98	2
Alaska	29	$180.92	$115.34	2
Idaho	20	$59.58	$49.42	1
Maine	16	$67.26	$43.11	1
Wyoming	15	$216.48	$173.02	1

Related codes

91065Measurement of hydrogen in breath to test for stomach and bowel sympto$62.96
91037Monitoring and recording of esophageal function through nasal tube$90.74
91035Monitoring and recording of esophageal function through a capsule atta$147.52
91040Study of esophageal sensation by balloon distension$51.11
91038Prolonged monitoring and recording of esophageal function through nasa$144.18
91034Monitoring and recording of esophageal function through nasal tube$120.21

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.