CPT 91034
Global 000 ActiveGastroesophageal reflux test
CPT 91034 Billing & Documentation Guide
CPT code 91034 (Gastroesophageal reflux test) is classified under Gastro Diagnostics with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.95, a non-facility practice expense RVU of 5.03, and a malpractice RVU of 0.08, a total non-facility RVU of 6.06 and facility RVU of 6.06. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $210, though rates vary from $177.42 to $278.92 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 91034, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 91034 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 91034 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 91034
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.95 | 0.95 |
| Practice Expense RVU | 5.03 | 5.03 |
| Malpractice RVU | 0.08 | 0.08 |
| Total RVU | 6.06 | 6.06 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 91034
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $233.12 | $233.12 | $217.84 - $278.92 | 29 |
| Florida | $205.5 | $205.5 | $196.36 - $213.38 | 3 |
| Georgia | $195.26 | $195.26 | $184.78 - $205.73 | 2 |
| Illinois | $199.29 | $199.29 | $189.3 - $209.23 | 4 |
| Michigan | $193.25 | $193.25 | $188.14 - $198.36 | 2 |
| North Carolina | $190.19 | $190.19 | $190.19 - $190.19 | 1 |
| New York | $224.3 | $224.3 | $193.22 - $238.48 | 5 |
| Ohio | $187.81 | $187.81 | $187.81 - $187.81 | 1 |
| Pennsylvania | $199.44 | $199.44 | $188.49 - $210.38 | 2 |
| Texas | $199.79 | $199.79 | $187.1 - $211.91 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 91034
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 91034 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0216T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 91034
What does CPT code 91034 mean? +
CPT code 91034 represents: Gastroesophageal reflux test. It's in the Gastro Diagnostics category with a global period of 000.
What is the Medicare reimbursement for CPT 91034? +
The 2026 Medicare national average non-facility payment for CPT 91034 is $210. Rates range from $177.42 to $278.92 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 91034? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 91034? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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