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Official Description

Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than 1 hour, up to 24 hours)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Gastroesophageal reflux impedance testing, identified by CPT® Code 91038, is a specialized diagnostic procedure designed to assess the function of the esophagus, particularly in relation to gastroesophageal reflux disease (GERD). This test evaluates esophageal peristalsis, which is the wave-like muscle contractions that move food down the esophagus, and monitors both acidic and non-acidic reflux over an extended duration, specifically from greater than one hour up to 24 hours. The procedure involves the placement of a nasal catheter equipped with intraluminal impedance electrodes, which are sensors that detect changes in electrical resistance as the bolus of fluid passes through the esophagus. The distal impedance electrode is strategically positioned approximately 5 cm above the distal esophageal sphincter to accurately capture the dynamics of esophageal function. During the test, the patient ingests a saline solution followed by a viscous material, allowing for comprehensive analysis of bolus transit times and the esophagus's effectiveness in moving contents into the stomach. The data collected by the electrodes is crucial for the physician's evaluation of esophageal function, leading to a detailed written report that aids in diagnosis and treatment planning. For tests lasting less than one hour, CPT® Code 91037 should be utilized.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The gastroesophageal reflux impedance test (CPT® Code 91038) is indicated for the evaluation of patients experiencing symptoms related to gastroesophageal reflux disease (GERD) and other esophageal disorders. The following conditions may warrant the performance of this test:

  • GERD Symptoms Patients presenting with chronic heartburn, regurgitation, or dysphagia may require this test to assess the severity and nature of their reflux.
  • Esophageal Motility Disorders Individuals suspected of having motility disorders, which affect the movement of food through the esophagus, can benefit from this evaluation.
  • Evaluation of Reflux Episodes The test is useful for monitoring both acidic and non-acidic reflux episodes, providing a comprehensive understanding of reflux characteristics.
  • Assessment of Treatment Efficacy Patients undergoing treatment for GERD may need this test to evaluate the effectiveness of their current management strategies.

2. Procedure

The procedure for the gastroesophageal reflux impedance test (CPT® Code 91038) involves several key steps to ensure accurate measurement and analysis of esophageal function:

  • Step 1: Catheter Insertion A nasal catheter containing intraluminal impedance electrodes is inserted through the patient's nose and carefully advanced into the esophagus. The distal impedance electrode is positioned approximately 5 cm above the distal esophageal sphincter to optimize the collection of data regarding esophageal function.
  • Step 2: Saline Swallowing Test Once the catheter is in place, the patient is instructed to swallow a saline solution. This phase involves taking 10 swallows at intervals of 20 to 30 seconds. As the saline bolus travels through the esophagus, the electrodes measure and record the transit times and dynamics of esophageal function.
  • Step 3: Viscous Material Swallowing Test Following the saline test, the patient is given a viscous material to swallow, repeating the process of taking 10 swallows at 20 to 30 second intervals. The electrodes again capture data on bolus transit times and esophageal function during this phase.
  • Step 4: Catheter Removal After the completion of the swallowing tests, the catheter is carefully removed from the patient's nose.
  • Step 5: Data Analysis The physician evaluates the recordings obtained from the electrodes, analyzing the data to assess esophageal function and reflux characteristics. A comprehensive written report is generated based on the findings.

3. Post-Procedure

After the gastroesophageal reflux impedance test (CPT® Code 91038) is completed, the patient may experience some minor discomfort due to the catheter insertion, but this typically resolves quickly. There are no specific post-procedure care requirements mentioned; however, patients are generally advised to resume normal activities unless otherwise directed by their physician. The physician will review the recorded data and provide a detailed report, which may include recommendations for further evaluation or treatment based on the findings of the test.

Short Descr ESOPH IMPED FUNCT TEST > 1HR
Medium Descr ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
Long Descr Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; prolonged (greater than 1 hour, up to 24 hours)
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Procedure or Service, Not Discounted when Multiple
Type of Service (TOS) 1 - Medical Care
Berenson-Eggers TOS (BETOS) P6C - Minor procedures - other (Medicare fee schedule)
MUE 1
CCS Clinical Classification 97 - Other gastrointestinal diagnostic procedures
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
GC This service has been performed in part by a resident under the direction of a teaching physician
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
TC Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
Action
Notes
2013-01-01 Changed Short Descriptor changed.
2005-01-01 Added First appearance in code book in 2005.
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