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CMS-1403-FC
Physi-
cian
Work
Fully
Implemented
Non-
Facility
PE
Year
2009
Transitional
Non-
Facility
PE
Fully
Imple-
mented
Facility
PE
Year
2009
Transi-
tional
Facility
PE
1 CPT codes and descriptions only are copyright 2008 American Medical Association. All Rights
Reserved. Applicable FARS/DFARS apply.
2 If values are reflected for codes not payable by Medicare, please note that these values have been
established as a courtesy to the general public and are not used for Medicare
payment.
1335
Mal-
Practice
RVUs 2 Global
CPT 1 /
HCPCS Mod Status Description
RVUs 2
RVUs 2
RVUs 2
RVUs 2
RVUs 2
91034 26 A Gastroesophageal reflux test 0.97 0.43 0.41 0.43 0.41 0.06 000
91035 A G-esoph reflx tst w/electrod 1.59 10.93 10.92 NA NA 0.12 000
91035 TC A G-esoph reflx tst w/electrod 0.00 10.19 10.23 NA NA 0.06 000
91035 26 A G-esoph reflx tst w/electrod 1.59 0.74 0.69 0.74 0.69 0.06 000
91037 A Esoph imped function test 0.97 3.32 3.23 NA NA 0.12 000
91037 TC A Esoph imped function test 0.00 2.86 2.80 NA NA 0.06 000
91037 26 A Esoph imped function test 0.97 0.46 0.43 0.46 0.43 0.06 000
91038 A Esoph imped funct test > 1h 1.10 2.70 2.59 NA NA 0.12 000
91038 TC A Esoph imped funct test > 1h 0.00 2.18 2.10 NA NA 0.06 000
91038 26 A Esoph imped funct test > 1h 1.10 0.52 0.49 0.52 0.49 0.06 000
91040 A Esoph balloon distension tst 0.97 8.45 9.14 NA NA 0.12 000
91040 TC A Esoph balloon distension tst 0.00 7.94 8.67 NA NA 0.06 000
91040 26 A Esoph balloon distension tst 0.97 0.51 0.47 0.51 0.47 0.06 000
91052 A Gastric analysis test 0.79 2.49 2.48 NA NA 0.05 000
91052 TC A Gastric analysis test 0.00 2.18 2.18 NA NA 0.02 000
91052 26 A Gastric analysis test 0.79 0.31 0.30 0.31 0.30 0.03 000
91055 A Gastric intubation for smear 0.94 2.46 2.58 NA NA 0.07 000
91055 TC A Gastric intubation for smear 0.00 2.16 2.29 NA NA 0.02 000
91055 26 A Gastric intubation for smear 0.94 0.30 0.29 0.30 0.29 0.05 000
91065 A Breath hydrogen test 0.20 1.56 1.54 NA NA 0.03 000
91065 TC A Breath hydrogen test 0.00 1.48 1.46 NA NA 0.02 000
91065 26 A Breath hydrogen test 0.20 0.08 0.08 0.08 0.08 0.01 000
91105 A Gastric intubation treatment 0.37 1.61 1.74 0.07 0.07 0.03 000
91110 A Gi tract capsule endoscopy 3.64 19.87 20.50 NA NA 0.16 XXX
91110 TC A Gi tract capsule endoscopy 0.00 18.13 18.87 NA NA 0.07 XXX
91110 26 A Gi tract capsule endoscopy 3.64 1.74 1.63 1.74 1.63 0.09 XXX
91111 A Esophageal capsule endoscopy 1.00 17.92 17.92 NA NA 0.05 XXX
91111 TC A Esophageal capsule endoscopy 0.00 17.45 17.45 NA NA 0.02 XXX
91111 26 A Esophageal capsule endoscopy 1.00 0.47 0.47 0.47 0.47 0.03 XXX
91120 A Rectal sensation test 0.97 8.84 9.40 NA NA 0.11 XXX
91120 TC A Rectal sensation test 0.00 8.53 9.08 NA NA 0.04 XXX
91120 26 A Rectal sensation test 0.97 0.31 0.32 0.31 0.32 0.07 XXX
91122 A Anal pressure record 1.77 4.03 4.31 NA NA 0.21 000
91122 TC A Anal pressure record 0.00 3.41 3.69 NA NA 0.08 000
91122 26 A Anal pressure record 1.77 0.62 0.62 0.62 0.62 0.13 000
91123 B Irrigate fecal impaction 0.00 0.00 0.00 0.00 0.00 0.00 XXX
91132 C Electrogastrography 0.00 0.00 0.00 NA NA 0.00 XXX
91132 TC C Electrogastrography 0.00 0.00 0.00 NA NA 0.00 XXX
91132 26 A Electrogastrography 0.52 0.26 0.24 0.26 0.24 0.02 XXX
91133 C Electrogastrography w/test 0.00 0.00 0.00 NA NA 0.00 XXX
91133 TC C Electrogastrography w/test 0.00 0.00 0.00 NA NA 0.00 XXX
91133 26 A Electrogastrography w/test 0.66 0.33 0.31 0.33 0.31 0.03 XXX
91299 C Gastroenterology procedure 0.00 0.00 0.00 NA NA 0.00 XXX
91299 TC C Gastroenterology procedure 0.00 0.00 0.00 NA NA 0.00 XXX
91299 26 C Gastroenterology procedure 0.00 0.00 0.00 0.00 0.00 0.00 XXX
92002 A Eye exam, new patient 0.88 0.96 0.96 0.28 0.30 0.02 XXX
92004 A Eye exam, new patient 1.82 1.62 1.64 0.61 0.63 0.04 XXX
92012 A Eye exam established pat 0.92 1.01 1.02 0.34 0.33 0.02 XXX