CPT 91125
Global XXX ActiveAnrct mano rct snsatn&balo
CPT 91125 Billing & Documentation Guide
CPT code 91125 (Anrct mano rct snsatn&balo) is classified under Gastro Diagnostics with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.7, a non-facility practice expense RVU of 7.53, and a malpractice RVU of 0.17, a total non-facility RVU of 10.4 and facility RVU of 10.4. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $359.37, though rates vary from $309.15 to $465.82 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 91125, 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 91125 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 91125
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.7 | 2.7 |
| Practice Expense RVU | 7.53 | 7.53 |
| Malpractice RVU | 0.17 | 0.17 |
| Total RVU | 10.4 | 10.4 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 91125
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 | $394.1 | $394.1 | $370.41 - $465.82 | 29 |
| Florida | $353.58 | $353.58 | $339.16 - $366.36 | 3 |
| Georgia | $337.06 | $337.06 | $321.3 - $352.81 | 2 |
| Illinois | $344.37 | $344.37 | $328.68 - $359.17 | 4 |
| Michigan | $334.34 | $334.34 | $326.22 - $342.46 | 2 |
| North Carolina | $328.47 | $328.47 | $328.47 - $328.47 | 1 |
| New York | $382.76 | $382.76 | $333.11 - $405.54 | 5 |
| Ohio | $325.53 | $325.53 | $325.53 - $325.53 | 1 |
| Pennsylvania | $343.41 | $343.41 | $326.43 - $360.4 | 2 |
| Texas | $343.56 | $343.56 | $324.33 - $361.49 | 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 91125
What does CPT code 91125 mean? +
CPT code 91125 represents: Anrct mano rct snsatn&balo. It's in the Gastro Diagnostics category with a global period of XXX.
What is the Medicare reimbursement for CPT 91125? +
The 2026 Medicare national average non-facility payment for CPT 91125 is $359.37. Rates range from $309.15 to $465.82 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 91125? +
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 91125? +
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 May 31, 2026.
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