CPT 91122 - Gastroenterology Modifier

Modifier used for Gastroenterology - Medicaid

91122 (Anorectal manometry)

Required Modifers :

The Required Modifiers column refers to services or procedures that require a split-bill modifier:

    -26    Professional Component

    -TC    Technical Component

    -ZS    Professional and Technical Component

    -99    Multiple Modifiers.  Explain in the Remarks area/Reserved For Local Use field (Box 19) of the claim form.  For further information about billing with modifier-99, see the Surgery:  Billing With Modifiers section in the appropriate Part 2 manual.

Allowable Modifiers : The Allowable Modifiers column refers to services or procedures that may use certain allowable modifiers to indicate that the procedure or service has been altered by some specific circumstance but not changed in its definition or code.  For a list of approved modifiers, refer to the Modifiers:  Approved List section in this manual.

Some procedures do not need further clarification with a modifier.  Use of modifiers not listed on the following chart will result in the claim being denied.


Required Modifier : TC, ZS, 26, 99

For CPTs :
91000 – 91030
91034 – 91038
91052 – 91065 91122
91132 – 91133


Allowable Modifier : 22, 99

For CPTs :
91090 – 91105


51784 (Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique) at the initial and final visits to assess the patient’s response. Careful: The code 91122 represents a study that is done to assess the patient with fecal incontinence, not urinary stress incontinence. This condition must be documented in the record in order to bill this study.