CPT 91124
Global XXX ActiveRct snsatn tone&cmplianc std
CPT 91124 Billing & Documentation Guide
CPT code 91124 (Rct snsatn tone&cmplianc std) is classified under Gastro Diagnostics with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.05, a non-facility practice expense RVU of 19.74, and a malpractice RVU of 0.22, a total non-facility RVU of 23.01 and facility RVU of 23.01. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $798.35, though rates vary from $672.02 to $1067.78 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 91124, 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 current NCCI edits before bundling with related codes.
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 91124 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 91124
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.05 | 3.05 |
| Practice Expense RVU | 19.74 | 19.74 |
| Malpractice RVU | 0.22 | 0.22 |
| Total RVU | 23.01 | 23.01 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 91124
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 | $889.68 | $889.68 | $830.17 - $1067.78 | 29 |
| Florida | $777.71 | $777.71 | $743.24 - $806.82 | 3 |
| Georgia | $739.83 | $739.83 | $698.76 - $780.89 | 2 |
| Illinois | $753.35 | $753.35 | $715.33 - $792.74 | 4 |
| Michigan | $731.33 | $731.33 | $712.14 - $750.52 | 2 |
| North Carolina | $721.73 | $721.73 | $721.73 - $721.73 | 1 |
| New York | $852.25 | $852.25 | $733.41 - $905.99 | 5 |
| Ohio | $711.25 | $711.25 | $711.25 - $711.25 | 1 |
| Pennsylvania | $756.47 | $756.47 | $714.09 - $798.84 | 2 |
| Texas | $758.37 | $758.37 | $708.69 - $806.16 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
Frequently Asked Questions, CPT 91124
What does CPT code 91124 mean? +
CPT code 91124 represents: Rct snsatn tone&cmplianc std. It's in the Gastro Diagnostics category with a global period of XXX.
What is the Medicare reimbursement for CPT 91124? +
The 2026 Medicare national average non-facility payment for CPT 91124 is $798.35. Rates range from $672.02 to $1067.78 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 91124? +
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 91124? +
No NCCI PTP edits currently on file for this code.
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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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