How much does Medicare pay for CPT 91040?

Medicare allowed an average of $51.11 per service and paid $39.85 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $605.15, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 91040?

Study of esophageal sensation by balloon distension. It was billed 3,353 times to 3,234 Medicare beneficiaries by 145 providers in 2024.

Does 91040 pay differently in an office than a hospital?

Yes. The allowed amount averaged $89.72 in an office setting and $48.70 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 91040 most?

Gastroenterology, with 2,309 services from 103 clinicians. Next are General Surgery, Thoracic Surgery, Internal Medicine.

CPT 91040

Study of esophageal sensation by balloon distension

$51.11Medicare-allowed amount per service, averaged across 3,353 services

Providers submitted

$605.15

Asking price, not received

Medicare allowed

$51.11

The fee schedule figure

Medicare paid

$39.85

Balance is patient coinsurance

Providers submitted an average of $605.15 for this code and Medicare allowed $51.11 — 11.8× 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 $39.85 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $89.72
Hospital / facility: $48.70

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. 197 services were billed in an office setting and 3,156 in a facility.

Services: 3,353
Beneficiaries: 3,234
Providers billing it: 145
Total allowed: $171,372

What Medicare pays for CPT 91040

Across 3,353 services billed by 145 providers to 3,234 beneficiaries, Medicare allowed an average of $51.11 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 91040

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	2,309	2,243	$52.69	103
General Surgery	782	736	$47.73	32
Thoracic Surgery	147	143	$47.06	5
Internal Medicine	35	34	$50.69	2
Cardiac Surgery	34	33	$44.87	1
General Practice	27	27	$45.59	1
Otolaryngology	19	18	$49.40	1

91040 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	433	$52.15	$36.71	19
Illinois	405	$68.27	$51.24	12
New York	253	$54.89	$37.17	13
Florida	241	$48.11	$36.64	11
Texas	225	$47.73	$37.09	10
New Jersey	166	$50.32	$36.27	8
Maryland	146	$51.04	$36.37	4
Colorado	123	$48.04	$37.13	6
Georgia	106	$47.18	$36.20	3
Missouri	102	$47.25	$35.91	6
Iowa	85	$44.52	$37.82	3
Wisconsin	77	$43.91	$37.58	4
South Carolina	76	$44.69	$37.17	2
Arizona	75	$46.73	$36.49	1
Massachusetts	67	$49.94	$37.92	4
Minnesota	65	$47.02	$36.77	4
Virginia	64	$46.08	$36.35	2
New Mexico	61	$47.12	$37.72	2
Louisiana	58	$48.36	$37.77	3
Pennsylvania	56	$49.87	$37.17	3
Kentucky	55	$43.88	$38.03	3
South Dakota	53	$45.11	$37.93	3
Mississippi	49	$44.84	$37.74	2
Kansas	43	$45.06	$36.13	2
North Carolina	42	$44.49	$35.35	2
Alabama	35	$44.48	$37.06	2
Ohio	32	$47.20	$37.63	2
Connecticut	31	$48.87	$38.41	1
New Hampshire	29	$47.60	$36.44	1
Nevada	21	$47.06	$36.00	1
Utah	18	$43.64	$38.19	1
West Virginia	16	$48.57	$37.76	1
Washington	12	$51.39	$35.23	1
Tennessee	11	$44.91	$28.05	1
Oregon	11	$48.29	$37.62	1
Michigan	11	$48.98	$37.78	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
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.