CPT Code 91065Complete Billing & Coding Guide (2026)Breath hydrogen/methane test
About CPT 91065
CPT 91065 is a Current Procedural Terminology code in the Gastro Diagnostics category maintained by the American Medical Association. The CMS short descriptor reads "Breath hydrogen/methane test". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
Documentation specificity, correct ICD-10 linkage, and modifier accuracy determine whether 91065 pays cleanly or triggers a denial. Verify CMS National Physician Fee Schedule status, applicable Medicare LCDs, and any payer-specific medical policies before submission.
91065 has 10 NCCI bundling edit pairs documented. Run your scrubber against the NCCI quarterly update before submission. When clinically warranted, use modifier 59 or the X-modifiers (XE, XS, XP, XU) to bypass an indicator-1 edit, with chart documentation supporting the distinct service.
Code Properties
RVU Breakdown
Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.
Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.
Medicare Payment by State
Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.
Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.
NCCI Bundling Edits
10 pairsThese codes trigger National Correct Coding Initiative edits when billed with 91065. An indicator of 0 means the pair cannot be unbundled. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with supporting documentation.
91065 + 0596T: bundled, modifier may bypass (indicator 1)
The most-asked bundling question on this code. Verdict pulled from the current NCCI quarterly file.
Modifier indicator 1 means a modifier may bypass the edit when the clinical scenario supports a distinct, separately identifiable service. Most billers default to modifier 59, but payers prefer the more specific X-modifiers (XE, XS, XP, XU) and pay them with less audit scrutiny. Documentation must establish the separation factor.
Standards of medical/surgical practice
Billing 91065 alongside a bundled code without the correct modifier generates CARC 97 denials. Payers often flag these as audit risks. Document medical necessity for the separate service and apply modifier 59 or the appropriate X-modifier (XE, XS, XP, XU) only when clinically justified.
Standards of medical/surgical practice
Standards of medical/surgical practice
Standards of medical/surgical practice
Standards of medical/surgical practice
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Misuse of Column Two code with Column One code
Bundling denials on 91065 are recoverable when the edit indicator is 1 and the chart documents a distinct, separately identifiable service. Our coders verify the indicator and pick the precise X-modifier (XE, XS, XP, XU) instead of defaulting to modifier 59.
Denied on 91065 + 0596T with the wrong modifier? Send us the EOB.
Most bundling denials on 91065 are recoverable when an X-modifier replaces a generic mod 59 and the chart supports a distinct service. A coder will read the EOB and the operative or procedure note for you.
Remove patient name, DOB, and member ID before pasting.
Applicable Modifiers
Modifiers commonly paired with 91065 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.
Modifier audits catch what scrubbers miss. Our AAPC-certified team reviews every modifier choice on 91065 against the chart documentation before submission, surfacing missed and misapplied modifiers across the practice.
Find the revenue leakage in your 91065 claims.
Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on Gastro Diagnostics claims. Our AAPC-certified team audits your last 90 days of 91065 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.
Losing revenue on CPT 91065? We’ll find it.
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Related CPT Codes
Codes in the same family as 91065
Specialty billing guides
CPT 91065 is among the top codes profiled in these specialty billing guides.
Everything about CPT 91065
What does CPT code 91065 cover?
CPT 91065 is a Current Procedural Terminology code in the Gastro Diagnostics category maintained by the American Medical Association. The CMS short descriptor reads "Breath hydrogen/methane test". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
What is the Medicare payment for CPT 91065?
The national average Medicare payment for CPT 91065 is approximately $64.46 in a non-facility setting and $64.46 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 1.93 with a conversion factor of $33.4009.
What is the global period for CPT 91065?
CPT 91065 has a 0-day global period (indicator 000). Same-day E/M is bundled into the procedure, but office visits the next day or after are separately billable for unrelated care. Use modifier 24 for unrelated E/M during the global period.
What codes bundle with CPT 91065?
CPT 91065 has NCCI Procedure-to-Procedure edits with 10+ codes including 0596T, 0597T, 0708T. Modifier indicator 0 means the edit cannot be bypassed. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with documentation.
CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.
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We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.