Physician codes 91010 to 91322 with Medicaid rates by state

23 physician codes from 91010 to 91322 carry a published Medicaid rate in ten or more states. The median shown is across those states' unmodified published rates; open a code for the full state-by-state table with percent of Medicare and prior-authorization flags.

CodeDescriptionStatesMedian rate
91010Esophagus muscle pressure study (manometry)48$181.71
91013Esophagus pressure study with stimulation (add-on)47$21.07
91020Stomach muscle pressure study (manometry)47$213.26
91022Duodenum muscle pressure study (manometry)46$157.89
91030Esophagus acid perfusion test (Bernstein)48$111.89
91034Esophagus acid reflux test with nasal pH probe48$168.15
91035Esophagus acid reflux test with a capsule pH probe48$398.20
91040Esophagus balloon distension test47$416.60
91065Breath hydrogen or methane test47$53.75
91110Capsule endoscopy, esophagus through small bowel48$686.66
91111Capsule endoscopy of the esophagus39$660.92
91112GI transit and pressure study, wireless capsule36$1,128.74
91113Colon capsule endoscopy37$780.40
91117Colon muscle pressure study (manometry), 6+ hours39$109.18
91120Rectal sensation, tone and compliance test11$454.47
91122Anorectal pressure study (manometry)11$252.78
91132Electrogastrography (stomach electrical activity)36$317.19
91133Electrogastrography with provocative testing35$339.63
91200Liver stiffness test (elastography), no imaging46$27.86
91299Unlisted GI diagnostic procedure10$143.92
91304COVID-19 vaccine, Novavax, 5 mcg dose33$182.32
91320COVID-19 mRNA vaccine, 30 mcg dose (Pfizer)37$168.25
91322COVID-19 mRNA vaccine, 50 mcg dose (Moderna)37$161.65

Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.