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Question: Does a physician have to be present when an esophageal manometry test (91010) is performed? I heard that Medicare has a new policy on this.
Colorado Subscriber
Answer: Medicare issued a new policy on the level of physician supervision required for esophageal manometry and other gastrointestinal tests performed in an office setting. Effective July 1, 2001, Medicare requires that a physician be in attendance in the room during the performance of an esophageal manometry if the global code (professional and technical components) is billed.
This policy applies only to tests performed in an office setting. In a hospital setting, the gastroenterologist cannot usually bill for the global code. He or she can bill usually only for the professional component, which is done by attaching modifier -26 to the procedure code. The technical component, which represents the value assigned to the ownership and maintenance of the manometry equipment and the use of any technicians, would be billed by the hospital.
Esophageal manometry is not the only test where personal supervision by a physician is now required. Almost all of the test procedures listed in the gastroenterology medicine section of CPT (91000-91122) have this new requirement.
A copy of transmittal B-01-28, which outlines this new policy, is available online at
www.hcfa.gov/pubforms/transmit/B0128.pdf.
