How much does Medicare pay for CPT 91122?

Medicare allowed an average of $202.62 per service and paid $159.25 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $728.77, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 91122?

Study of rectum sensitivity and function. It was billed 14,626 times to 12,727 Medicare beneficiaries by 447 providers in 2024.

Does 91122 pay differently in an office than a hospital?

Yes. The allowed amount averaged $247.81 in an office setting and $85.78 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 91122 most?

Gastroenterology, with 7,061 services from 241 clinicians. Next are Colorectal Surgery (Proctology), Urology, Nurse Practitioner.

CPT 91122

Study of rectum sensitivity and function

$202.62Medicare-allowed amount per service, averaged across 14,626 services

Providers submitted

$728.77

Asking price, not received

Medicare allowed

$202.62

The fee schedule figure

Medicare paid

$159.25

Balance is patient coinsurance

Providers submitted an average of $728.77 for this code and Medicare allowed $202.62 — 3.6× 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 $159.25 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $247.81
Hospital / facility: $85.78

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. 10,547 services were billed in an office setting and 4,079 in a facility.

Services: 14,626
Beneficiaries: 12,727
Providers billing it: 447
Total allowed: $2,963,520

What Medicare pays for CPT 91122

Across 14,626 services billed by 447 providers to 12,727 beneficiaries, Medicare allowed an average of $202.62 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 91122

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	7,061	6,994	$170.95	241
Colorectal Surgery (Proctology)	2,382	2,196	$224.19	75
Urology	1,794	866	$276.15	27
Nurse Practitioner	1,379	1,211	$192.29	40
Obstetrics & Gynecology	1,063	721	$261.01	28
Physician Assistant	407	218	$209.82	13
Internal Medicine	276	275	$179.10	10
General Surgery	248	230	$194.01	12
Radiation Oncology	16	16	$92.91	1

91122 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	1,855	$206.99	$141.10	51
Florida	1,544	$233.13	$187.64	55
New York	1,262	$276.57	$190.36	37
Texas	1,121	$210.60	$171.08	35
Minnesota	1,028	$188.50	$146.98	24
Ohio	784	$120.70	$98.61	22
Nevada	679	$262.27	$210.61	5
Illinois	613	$207.43	$160.30	18
Arizona	555	$256.54	$203.26	14
Pennsylvania	383	$136.43	$106.63	14
Missouri	353	$180.57	$154.39	8
Massachusetts	346	$124.23	$89.18	13
Virginia	328	$213.18	$168.51	11
Georgia	307	$146.41	$116.12	10
North Carolina	292	$154.24	$126.09	11
Maryland	266	$212.98	$150.23	12
Maine	233	$273.83	$211.19	2
Louisiana	231	$181.02	$147.99	9
New Jersey	224	$269.91	$192.67	10
Michigan	197	$177.79	$142.92	10
Colorado	193	$194.03	$149.03	7
New Hampshire	191	$131.33	$105.38	2
Nebraska	133	$162.85	$133.19	4
Alabama	129	$196.55	$172.43	6
Iowa	126	$105.43	$82.13	2
Tennessee	117	$177.46	$149.45	5
Connecticut	115	$144.84	$103.41	6
Washington	114	$91.01	$65.40	4
Mississippi	113	$121.72	$105.84	4
Utah	108	$197.67	$160.93	4
Wisconsin	83	$81.37	$65.61	4
Kansas	72	$156.00	$129.56	3
Indiana	66	$222.24	$179.02	4
Oregon	60	$223.08	$168.87	4
Arkansas	59	$205.78	$184.87	3
South Dakota	59	$82.47	$62.74	2
Rhode Island	51	$213.53	$166.13	2
West Virginia	41	$124.56	$111.91	1
Delaware	39	$269.07	$215.46	1
Oklahoma	32	$241.84	$217.44	1
South Carolina	32	$144.64	$112.57	2
District of Columbia	27	$98.95	$67.33	1
Vermont	26	$184.60	$147.02	1
Hawaii	16	$300.36	$215.87	1
North Dakota	12	$82.85	$56.07	1
New Mexico	11	$88.03	$65.22	1

Related codes

91110Imaging of digestive tract done from the inside of the digestive tract$471.78
91120Test for tone and sensation of rectum and anus$320.34

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.