How much does Medicare pay for CPT 91120?

Medicare allowed an average of $320.34 per service and paid $250.71 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1062.91, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 91120?

Test for tone and sensation of rectum and anus. It was billed 8,541 times to 8,306 Medicare beneficiaries by 303 providers in 2024.

Does 91120 pay differently in an office than a hospital?

Yes. The allowed amount averaged $430.37 in an office setting and $47.55 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 91120 most?

Gastroenterology, with 4,854 services from 168 clinicians. Next are Colorectal Surgery (Proctology), Nurse Practitioner, Obstetrics & Gynecology.

CPT 91120

Test for tone and sensation of rectum and anus

$320.34Medicare-allowed amount per service, averaged across 8,541 services

Providers submitted

$1062.91

Asking price, not received

Medicare allowed

$320.34

The fee schedule figure

Medicare paid

$250.71

Balance is patient coinsurance

Providers submitted an average of $1062.91 for this code and Medicare allowed $320.34 — 3.3× 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 $250.71 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $430.37
Hospital / facility: $47.55

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. 6,086 services were billed in an office setting and 2,455 in a facility.

Services: 8,541
Beneficiaries: 8,306
Providers billing it: 303
Total allowed: $2,736,024

What Medicare pays for CPT 91120

Across 8,541 services billed by 303 providers to 8,306 beneficiaries, Medicare allowed an average of $320.34 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 91120

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	4,854	4,816	$282.15	168
Colorectal Surgery (Proctology)	2,101	1,958	$396.43	68
Nurse Practitioner	603	600	$317.25	25
Obstetrics & Gynecology	345	318	$390.91	12
Internal Medicine	235	232	$298.27	9
General Surgery	235	217	$310.58	11
Physician Assistant	90	88	$357.98	5
Urology	62	61	$504.03	4
Radiation Oncology	16	16	$51.18	1

91120 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	1,179	$263.59	$170.60	39
Florida	881	$367.19	$298.34	37
New York	715	$459.91	$311.58	26
Ohio	519	$160.19	$137.28	14
Minnesota	426	$499.21	$381.29	11
Illinois	392	$322.39	$248.51	13
Massachusetts	386	$251.39	$184.24	13
Texas	383	$340.18	$278.97	16
Georgia	285	$190.33	$153.79	9
North Carolina	274	$201.37	$163.46	10
Arizona	207	$481.43	$381.39	9
Pennsylvania	204	$250.65	$198.61	7
Missouri	204	$422.41	$366.25	4
Virginia	204	$421.31	$332.52	6
New Jersey	195	$478.07	$341.40	8
Louisiana	186	$294.61	$241.92	6
Maryland	184	$327.21	$232.05	10
Michigan	173	$269.34	$214.97	8
Colorado	164	$352.25	$262.85	6
Maine	154	$483.18	$380.45	2
New Hampshire	140	$46.46	$35.93	1
Alabama	117	$317.26	$284.54	5
Utah	109	$324.82	$271.22	4
Tennessee	86	$401.35	$364.80	5
Connecticut	77	$117.66	$82.29	4
Iowa	74	$115.24	$97.06	2
Mississippi	70	$180.63	$165.72	2
Arkansas	59	$345.91	$303.04	3
South Dakota	59	$45.38	$34.52	2
Nevada	47	$453.50	$332.52	2
Indiana	40	$471.58	$390.66	2
Wisconsin	39	$44.82	$36.97	2
Delaware	39	$486.45	$388.72	1
West Virginia	38	$166.00	$160.32	1
Rhode Island	34	$507.89	$356.38	1
Washington	32	$309.31	$192.38	2
Oklahoma	32	$430.70	$383.91	1
District of Columbia	27	$54.47	$37.05	1
Oregon	24	$515.23	$391.46	2
South Carolina	17	$44.99	$36.99	1
Hawaii	16	$558.07	$391.06	1
Nebraska	15	$47.09	$36.98	1
North Dakota	12	$45.60	$30.86	1
Kansas	12	$310.75	$239.30	1
New Mexico	11	$48.31	$33.71	1

Related codes

91110Imaging of digestive tract done from the inside of the digestive tract$471.78
91122Study of rectum sensitivity and function$202.62

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.