How much does Medicare pay for CPT 91035?

Medicare allowed an average of $147.52 per service and paid $116.06 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1205.33, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 91035?

Monitoring and recording of esophageal function through a capsule attached to the esophagus wall. It was billed 4,499 times to 4,466 Medicare beneficiaries by 221 providers in 2024.

Does 91035 pay differently in an office than a hospital?

Yes. The allowed amount averaged $285.52 in an office setting and $110.14 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 91035 most?

Gastroenterology, with 2,265 services from 121 clinicians. Next are General Surgery, Ambulatory Surgical Center, Physician Assistant.

CPT 91035

Monitoring and recording of esophageal function through a capsule attached to the esophagus wall

$147.52Medicare-allowed amount per service, averaged across 4,499 services

Providers submitted

$1205.33

Asking price, not received

Medicare allowed

$147.52

The fee schedule figure

Medicare paid

$116.06

Balance is patient coinsurance

Providers submitted an average of $1205.33 for this code and Medicare allowed $147.52 — 8.2× 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 $116.06 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $285.52
Hospital / facility: $110.14

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. 959 services were billed in an office setting and 3,540 in a facility.

Services: 4,499
Beneficiaries: 4,466
Providers billing it: 221
Total allowed: $663,692

What Medicare pays for CPT 91035

Across 4,499 services billed by 221 providers to 4,466 beneficiaries, Medicare allowed an average of $147.52 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 91035

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	2,265	2,246	$133.73	121
General Surgery	1,121	1,112	$122.51	48
Ambulatory Surgical Center	592	589	$270.76	29
Physician Assistant	166	166	$66.21	7
Internal Medicine	133	132	$271.70	5
Nurse Practitioner	114	114	$65.93	5
Thoracic Surgery	54	54	$83.28	3
General Practice	28	28	$75.10	1
Family Practice	14	14	$76.02	1
Cardiac Surgery	12	11	$73.85	1

91035 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	728	$151.94	$107.21	35
Florida	440	$213.59	$175.15	21
Texas	348	$82.60	$65.17	16
Minnesota	257	$217.88	$173.98	10
Illinois	231	$99.73	$71.81	12
New York	226	$234.46	$163.77	13
Colorado	209	$263.84	$207.63	8
South Carolina	182	$179.94	$154.04	9
Pennsylvania	178	$68.89	$56.01	9
Georgia	172	$137.34	$114.26	8
Washington	150	$96.34	$68.83	9
Arizona	107	$165.16	$127.26	5
Virginia	97	$120.26	$98.10	5
North Carolina	93	$101.79	$87.81	4
Ohio	93	$76.30	$61.26	5
Maryland	90	$110.01	$80.07	4
Kentucky	87	$131.71	$114.67	4
Iowa	68	$69.53	$56.37	3
Missouri	64	$75.68	$59.64	3
Montana	64	$130.32	$104.72	3
Tennessee	61	$73.34	$63.23	3
South Dakota	58	$75.55	$61.25	4
Oregon	56	$390.94	$282.55	3
New Hampshire	48	$78.28	$57.13	2
Wisconsin	48	$79.41	$67.76	2
Idaho	46	$73.87	$60.88	3
Oklahoma	46	$159.29	$138.00	2
Louisiana	45	$172.77	$156.89	3
Mississippi	44	$74.63	$61.59	3
New Mexico	29	$81.97	$62.37	1
Utah	25	$180.78	$149.46	2
Nevada	22	$77.56	$62.27	1
Alabama	19	$62.43	$52.84	1
Vermont	15	$75.82	$62.03	1
West Virginia	14	$79.80	$53.71	1
New Jersey	14	$73.22	$62.37	1
Massachusetts	13	$67.68	$48.88	1
Michigan	12	$74.85	$63.67	1

Related codes

91065Measurement of hydrogen in breath to test for stomach and bowel sympto$62.96
91010Study of esophagus to assess movement$95.29
91037Monitoring and recording of esophageal function through nasal tube$90.74
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.