CPT code 91122 – Anorectal manometry billing and 2026 deletion

Key takeaways

CPT code 91122 described anorectal manometry, a study of anal sphincter pressures, rectal sensation, and the rectoanal inhibitory reflex.

The AMA deleted 91122 and 91120 effective January 1, 2026. Anorectal manometry is now 91125, and rectal sensation, tone, and compliance testing is 91124.

A claim that reports 91122 for a date of service on or after January 1, 2026 is invalid and will be denied.

Claims need a physician order, a documented indication such as K59.0x or R15.x, a manometry report with pressure values, and a signed interpretation.

In Pabau’s practice management software, claims go out through Claim.MD and their status is tracked, so a denied manometry line shows up early.

CPT code 91122: official descriptor and procedure scope

CPT code 91122 was the code for anorectal manometry until the AMA deleted it effective January 1, 2026. Its official descriptor was simply “Anorectal manometry.” In fact, the code sat in the gastroenterology section, 91010-91299, of the AMA’s CPT code set.

First, the study measures internal and external anal sphincter pressures, rectal sensation, and the rectoanal inhibitory reflex. As a result, anorectal manometry is reported with 91125 from January 1, 2026. That code may also include rectal sensation testing and a balloon expulsion test. In contrast, rectal sensation, tone, and compliance testing, such as a barostat study, moved from deleted 91120 to the new code 91124.

What the procedure measures clinically

Anorectal manometry (ARM) evaluates four measures that coders should look for in the report:

• Resting sphincter pressure: baseline internal anal sphincter tone; reduced in patients with fecal incontinence
• Squeeze pressure: voluntary external sphincter contraction; reduced in sphincter injury or pudendal neuropathy
• Rectal sensation thresholds: volumes at first sensation, urge, and maximum tolerable capacity; elevated in rectal hyposensitivity and some constipation
• Rectoanal inhibitory reflex (RAIR): transient relaxation of the internal sphincter following rectal distension; absent in Hirschsprung disease

In short, a complete ARM report documents all four measures. Payers reviewing the claim look for numeric pressure values and a physician interpretation, so a report missing either one invites a documentation denial.

CPT 91122 deleted in 2026: what changed and why

The AMA deleted CPT 91122 and its companion code 91120 effective January 1, 2026. Indeed, the AMA RVS Update Committee found the two were reported by the same physician on the same date more than 75% of the time.

Two new Category I codes replace the pair. First, code 91124 reports rectal sensation, tone, and compliance testing, such as a barostat study. Second, code 91125 reports anorectal manometry and may include rectal sensation testing and balloon expulsion. However, the new codes do not split by catheter type or by conventional versus high-resolution technology, as the crosswalk below shows.

As a result, a 91122 claim for a date of service on or after January 1, 2026 is rejected at the clearinghouse or denied by the payer. Payers do not convert the deleted code on their own, so the practice selects the successor code from the study documented.

Replacement CPT codes for anorectal manometry after 91122 deletion

The AMA added two codes to the 2026 CPT code set to replace 91120 and 91122. Therefore, confirm the full descriptors in the AMA CPT 2026 manual or the AAPC entry for CPT 91125 before billing.

ICD-10 diagnosis codes that support medical necessity

Payers require a linked ICD-10-CM diagnosis code to establish medical necessity for anorectal manometry. The codes below are commonly documented indications. In addition, the code on the claim must match the symptom documented in the record and the payer’s own policy.

A specific code such as K59.02 (outlet dysfunction constipation) states the indication more clearly than K59.00 (constipation, unspecified). However, use it only when the record documents outlet dysfunction, along with the treatment already tried.

Medicare coverage for anorectal manometry

Medicare coverage for anorectal manometry is set locally by each Medicare Administrative Contractor (MAC). Therefore, search the Medicare Coverage Database for your MAC’s local coverage determination (LCD) or billing article on anorectal manometry.

That policy lists the covered indications, the documentation the contractor expects, and any frequency limits. In contrast, commercial payers write their own policies and may add prior authorization, so confirm each plan’s rules through insurance eligibility verification before scheduling the study.

Documentation requirements for CPT code 91122 claims

In short, strong documentation protects claims from medical necessity audits and supports appeals when initial denials occur. For solid medical billing compliance, the clinical record supporting an anorectal manometry claim should contain the following elements.

• Physician or qualified NPP order specifying anorectal manometry and the clinical indication
• Documented indication with the ICD-10-CM diagnosis code and a narrative describing symptoms, duration, and prior treatment history
• Technique description identifying catheter type (water-perfused, solid-state, or high-resolution), channel count, and the maneuvers performed
• Pressure measurement data including resting pressure, maximum squeeze pressure, push pressure, and sensory thresholds, expressed as numeric values in mmHg
• Rectoanal inhibitory reflex documentation when tested, including balloon volumes and reflex presence or absence
• Physician interpretation narrative comparing findings to normal reference ranges and correlating with the clinical diagnosis
• Provider credentials confirming the interpreting physician’s specialty and supervision status for the technical component

For example, a tracing or raw data printout without physician commentary does not support the professional component. So, check for the signed interpretation before the claim goes out.

Applicable modifiers for CPT code 91122

Modifier selection depends on the practice setting, who owns the equipment, and whether other services were performed on the same date. Overall, the table covers the modifiers most often used with 91122 for dates of service through December 31, 2025. Before applying 26 or TC to 91124 or 91125, confirm each code’s PC/TC indicator in the CY2026 Medicare Physician Fee Schedule.

When the physician owns the equipment and performs the study in a non-facility setting, bill the global code with no modifier. The payer then pays both professional and technical components in a single payment. In contrast, billing -26 and the global code on the same claim is a duplicate billing error that payers deny.

Medicare reimbursement rates for CPT code 91122

The CMS Physician Fee Schedule sets national payment for 91122, adjusted by locality and by facility or non-facility setting. Look up the CY2025 relative value units and rates there for dates of service through December 31, 2025.

From January 1, 2026, the fee schedule prices 91124 and 91125 instead. As a result, rate lookups for new services should move to those two codes.

Common claim denial reasons and how to avoid them

Anorectal manometry sits across gastroenterology, colorectal surgery, and pelvic floor rehabilitation, and payer expectations differ between them. In addition, the 2026 deletion adds a new denial risk for any claim still carrying 91122.

Indeed, a denial management workflow that sorts denials by root cause will surface “deleted code” rejections quickly after January 1, 2026. The billing team can then correct and resubmit those claims with the successor codes. In addition, a clean claim checklist for anorectal manometry should cover diagnosis specificity, modifier logic, and prior authorization.

In fact, each rejection carries CARC and RARC codes that explain the payer’s reason. Our denial codes reference decodes them, so staff can tell a deleted-code rejection from a medical necessity denial.

CPT 91122 vs adjacent codes: avoiding confusion and unbundling errors

Several GI motility and pelvic floor codes are billed alongside or confused with CPT code 91122. Therefore, knowing where each one stops helps prevent unbundling and upcoding. Esophageal motility testing, for example, is billed as 91010 and covers a different organ system entirely.

In addition, use CrossCoder for bidirectional procedure-to-diagnosis crosswalk verification when billing multiple motility codes on the same date.

How claims management software supports anorectal manometry billing

After the 2026 deletion, a manometry claim can fail on the retired code, a weak diagnosis link, or a missing interpretation. As a result, billing teams working from spreadsheets and payer portals often see those problems only when the remittance arrives.

Pabau, the practice management platform we build, keeps the order, the manometry report, and the claim in the same patient record. In addition, its streamlined claims management submits claims through Claim.MD, our US clearinghouse partner, and tracks the status of each one.

Denied claims are visible alongside the patient record. Instead, the billing team can correct a 91122 line to 91125 and resubmit it without chasing paper remittances.

Keep manometry claims moving after 2026

Pabau submits claims through Claim.MD, tracks their status, and shows denials alongside the patient record. See how it handles motility and pelvic floor billing in a live demo.

Book a demo

Conclusion

For any date of service on or after January 1, 2026, 91122 is no longer a valid code, and neither is 91120. Therefore, move the charge master to 91124 and 91125 now, and make sure staff know which study each successor covers.

However, claims from late 2025 still bill under 91122, so keep the old codes available until those claims close. After that, a single 91122 on a new claim is a guaranteed denial.

Book a demo to see how Pabau tracks manometry claims from submission to payment across the 2026 code change.

Continue your research

Need to understand clearinghouse submission for GI claims? Medical claims clearinghouse guide explains how 837P files route from practice to payer and where claims fail in transit.

Working through a post-deletion denial appeal? Electronic remittance advice explained covers how to read ERA 835 files and identify the CARC denial reason for deleted-code rejections.

Looking for the superbill structure for procedures? Superbill guide covers how to structure a compliant superbill with procedure and diagnosis codes.

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