How much does Medicare pay for CPT 91038?

Medicare allowed an average of $144.18 per service and paid $112.95 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $796.91, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 91038?

Prolonged monitoring and recording of esophageal function through nasal tube with electrode. It was billed 1,960 times to 1,936 Medicare beneficiaries by 84 providers in 2024.

Does 91038 pay differently in an office than a hospital?

Yes. The allowed amount averaged $319.78 in an office setting and $53.59 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 91038 most?

Gastroenterology, with 1,659 services from 73 clinicians. Next are General Surgery, Internal Medicine, Otolaryngology.

CPT 91038

Prolonged monitoring and recording of esophageal function through nasal tube with electrode

$144.18Medicare-allowed amount per service, averaged across 1,960 services

Providers submitted

$796.91

Asking price, not received

Medicare allowed

$144.18

The fee schedule figure

Medicare paid

$112.95

Balance is patient coinsurance

Providers submitted an average of $796.91 for this code and Medicare allowed $144.18 — 5.5× 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 $112.95 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $319.78
Hospital / facility: $53.59

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. 667 services were billed in an office setting and 1,293 in a facility.

Services: 1,960
Beneficiaries: 1,936
Providers billing it: 84
Total allowed: $282,593

What Medicare pays for CPT 91038

Across 1,960 services billed by 84 providers to 1,936 beneficiaries, Medicare allowed an average of $144.18 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 91038

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	1,659	1,639	$137.73	73
General Surgery	125	123	$55.28	4
Internal Medicine	63	63	$123.82	3
Otolaryngology	60	59	$416.37	1
Family Practice	24	23	$401.64	1
Physician Assistant	17	17	$43.71	1
Nurse Practitioner	12	12	$335.21	1

91038 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	197	$59.09	$41.03	9
North Carolina	174	$106.74	$87.17	6
Texas	163	$81.87	$62.82	7
New York	133	$415.75	$282.34	7
Pennsylvania	127	$173.41	$131.16	5
Illinois	112	$56.90	$41.79	4
Massachusetts	107	$258.38	$194.97	4
Ohio	100	$51.63	$41.79	4
New Hampshire	91	$53.37	$39.53	1
Maryland	86	$227.02	$173.92	5
Florida	76	$316.77	$259.43	3
Washington	71	$315.35	$223.50	4
South Carolina	61	$51.22	$41.99	3
Michigan	54	$54.78	$40.09	2
Missouri	54	$52.51	$41.41	2
Nebraska	53	$52.30	$41.84	2
Virginia	41	$59.00	$41.37	1
Arizona	40	$52.95	$38.33	3
Alabama	39	$50.45	$40.30	1
Oregon	28	$201.84	$149.85	2
Montana	25	$53.28	$42.48	1
Minnesota	24	$401.64	$310.12	1
Iowa	20	$52.03	$40.28	1
Colorado	18	$51.65	$39.43	1
Kentucky	15	$54.46	$42.36	1
Indiana	14	$366.20	$314.89	1
Kansas	13	$330.76	$311.64	1
Nevada	12	$335.21	$262.40	1
South Dakota	12	$52.23	$38.95	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
91035Monitoring and recording of esophageal function through a capsule atta$147.52
91040Study of esophageal sensation by balloon distension$51.11
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.