91037
Esoph imped function test
Code typePrimary
Payment statusActive (A)
Global period0-day
Whole-Procedure Pricing
Line
Qty
Global fee
Pro fee
Primary91037Esoph imped function test
1
$187.38
$187.38
RVU Breakdown
Component
Office
Facility
Work
0.95
0.95
Practice expense
4.59
4.59
Malpractice
0.07
0.07
Total RVU
5.61
5.61
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