91030
Acid perfusion of esophagus
Code typePrimary
Payment statusActive (A)
Global period0-day
Whole-Procedure Pricing
Line
Qty
Global fee
Pro fee
Primary91030Acid perfusion of esophagus
1
$162.66
$162.66
RVU Breakdown
Component
Office
Facility
Work
0.89
0.89
Practice expense
3.93
3.93
Malpractice
0.05
0.05
Total RVU
4.87
4.87
Payment Policy & Modifiers
Allowed adjustments
Assistant surgeon -80/81/8216% · documented
Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.
Prof / tech split -26 / -TCSplit
Has professional (-26) and technical (-TC) components, each priced separately.
Not applicable to this code
Bilateral -50Multiple procedure Co-surgeon -62Team surgeon -66