How much does Medicare pay for CPT 91065?

Medicare allowed an average of $62.96 per service and paid $47.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $221.72, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 91065?

Measurement of hydrogen in breath to test for stomach and bowel symptoms. It was billed 44,757 times to 27,022 Medicare beneficiaries by 462 providers in 2024.

Does 91065 pay differently in an office than a hospital?

Yes. The allowed amount averaged $69.07 in an office setting and $9.63 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 91065 most?

Clinical Laboratory, with 26,241 services from 6 clinicians. Next are Gastroenterology, Nurse Practitioner, Pathology.

CPT 91065

Measurement of hydrogen in breath to test for stomach and bowel symptoms

$62.96Medicare-allowed amount per service, averaged across 44,757 services

Providers submitted

$221.72

Asking price, not received

Medicare allowed

$62.96

The fee schedule figure

Medicare paid

$47.35

Balance is patient coinsurance

Providers submitted an average of $221.72 for this code and Medicare allowed $62.96 — 3.5× 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 $47.35 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $69.07
Hospital / facility: $9.63

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. 40,159 services were billed in an office setting and 4,598 in a facility.

Services: 44,757
Beneficiaries: 27,022
Providers billing it: 462
Total allowed: $2,817,901

What Medicare pays for CPT 91065

Across 44,757 services billed by 462 providers to 27,022 beneficiaries, Medicare allowed an average of $62.96 per service. That is 1.7 services per beneficiary, so this is a code patients typically receive more than once. 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 91065

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	26,241	12,953	$72.80	6
Gastroenterology	13,124	10,028	$48.84	349
Nurse Practitioner	2,473	1,778	$41.44	57
Pathology	1,237	862	$83.76	4
Internal Medicine	663	551	$49.12	22
Physician Assistant	616	538	$35.79	19
Pediatric Medicine	264	203	$11.57	2
Radiation Oncology	97	67	$10.40	1
General Surgery	26	26	$64.69	1
Nuclear Medicine	16	16	$9.82	1

91065 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
Arizona	15,506	$70.64	$54.59	14
Massachusetts	10,973	$73.40	$52.33	19
California	3,401	$39.78	$25.29	47
North Carolina	2,105	$55.15	$43.31	23
New York	2,022	$67.68	$44.29	48
Maryland	1,180	$74.71	$48.03	12
Texas	1,008	$59.11	$46.48	28
New Jersey	785	$78.06	$51.57	33
Iowa	751	$41.25	$31.93	15
Florida	742	$63.64	$48.94	28
Minnesota	611	$15.47	$11.29	18
Nebraska	498	$61.66	$46.25	10
Michigan	465	$21.49	$16.44	8
Georgia	447	$17.56	$13.37	5
Ohio	442	$24.44	$18.81	12
Connecticut	442	$38.43	$26.93	12
Pennsylvania	418	$39.32	$29.74	15
Virginia	371	$51.60	$37.70	13
Illinois	321	$44.52	$33.54	15
Missouri	316	$49.11	$38.11	11
Tennessee	310	$66.52	$52.52	17
Colorado	234	$25.08	$17.60	7
Nevada	170	$69.50	$52.49	5
Utah	149	$30.89	$23.20	5
Washington	121	$46.71	$34.34	4
South Carolina	108	$62.44	$52.89	6
Kansas	102	$51.03	$43.41	4
Mississippi	82	$65.24	$55.28	3
Wisconsin	80	$9.16	$7.10	5
Oregon	76	$53.75	$45.42	2
New Hampshire	75	$23.81	$17.16	2
New Mexico	69	$50.64	$43.95	2
North Dakota	56	$9.23	$7.25	2
Maine	42	$73.28	$49.64	1
Kentucky	42	$43.79	$36.27	2
South Dakota	39	$9.25	$7.55	1
District of Columbia	34	$14.33	$11.78	1
Louisiana	30	$64.80	$57.84	1
Wyoming	29	$37.36	$27.88	1
Oklahoma	29	$62.53	$57.87	1
Arkansas	29	$58.64	$56.06	1
Delaware	20	$69.77	$52.83	1
West Virginia	15	$9.24	$7.07	1
XX	12	$7.95	$6.43	1

Related codes

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
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.