CPT 91122 Deleted in 2026: What Changed, New Anorectal Manometry Coding & Billing Guide
What replaced 91122, how the new codes differ, and the workflow touchpoints where a deleted code keeps resurfacing.
Quick Answer: What Happened to CPT 91122? CPT 91122 was deleted effective January 1, 2026, and should not be used as an active 2026 code. CPT 91120 was deleted at the same time. Two new Category I codes replaced them: 91124 for rectal sensation, tone, and compliance study (e.g., barostat), and 91125 for anorectal manometry with rectal sensation and rectal balloon expulsion test, when performed. Code selection still depends on the service actually performed, the current CPT descriptor, and the documentation -- and payer coverage and billing requirements still need to be verified separately. |
A gastroenterology practice runs an anorectal manometry study in February 2026, the charge drops the way it always has, and the claim bounces back. Nothing about the test changed. What changed is that the code on the claim no longer exists.
CPT 91122 was deleted effective January 1, 2026, along with CPT 91120. Both were replaced by a restructured pair of codes that reflect how these studies are actually performed. The coding reference change is the easy part -- the harder part is that a deleted code tends to survive inside an EHR, a charge master, a superbill, and a staff cheat sheet long after the codebook is updated.
This guide covers what changed on January 1, what the new codes represent, how billing teams should approach the transition, and where outdated code references create avoidable claim problems in 2026.
What Changed: The 2026 Timeline
2025 and earlier | CPT 91120 and 91122 reported under the prior structure, frequently billed together |
January 1, 2026 | 91120 and 91122 DELETED -- 2026 CPT changes take effect |
2026 forward | Review 91124 and 91125 against the service actually performed and documented |
Why the Codes Changed
This wasn't an arbitrary renumbering. The AMA's Relative Value Scale Update Committee identified 91120 and 91122 as a code pair reported together more than 75% of the time, which pointed to duplicative reporting and overlapping work between the two. The GI societies were directed to submit a CPT application creating a bundled structure, and the result was 91124 and 91125.
The practical effect: the new codes draw a clear line between barostat-based testing and anorectal manometry, so the dual-reporting pattern that drove the review is no longer necessary. Per current CPT guidance, 91124 and 91125 are not reported together on the same date of service.
CPT 91122 vs. 2026 Coding
Coding Question | Historical CPT 91122 | 2026 Coding Consideration |
Status | Deleted effective January 1, 2026 | Use current active codes only |
Effective date | Valid for dates of service before 1/1/2026 | 2026 changes apply to DOS on or after 1/1/2026 |
Procedure/test | Anorectal manometry under the prior structure | 91125 -- anorectal manometry, with rectal sensation and rectal balloon expulsion test, when performed |
Companion code | Often reported alongside 91120 | 91124 covers rectal sensation, tone, and compliance study (e.g., barostat) |
Reporting together | 91120 + 91122 commonly billed as a pair | 91124 and 91125 are not reported together on the same date of service |
Documentation | Prior requirements | Current documentation must support the specific service billed |
Payer policy | Prior policy | Verify current payer coverage and billing requirements |
What Are CPT 91124 and 91125?
CPT 91125 covers anorectal manometry, including rectal sensation and rectal balloon expulsion test when those are performed. The "when performed" language matters -- the sensation and balloon expulsion components are captured within the code rather than reported separately.
CPT 91124 covers rectal sensation, tone, and compliance study -- for example, barostat testing. This is the code that replaced 91120's territory.
The distinction between them is the type of study performed, not simply which code a practice used to bill. That's why a blanket assumption that everything previously billed under 91122 now goes to 91125 isn't safe. The correct code depends on the actual service performed and the requirements of the current CPT definition and payer policy. There's also a related instruction worth checking: colon motility study code 91117 is not reported in conjunction with 91124 or 91125.
Is Your Billing Workflow Still Using CPT 91122?
☐ Does your EHR still display CPT 91122 as selectable?
☐ Does your charge master still contain 91122?
☐ Is 91122 included on an internal coding cheat sheet?
☐ Are staff still referencing pre-2026 coding materials?
☐ Has the 2026 CPT update been applied across systems?
☐ Has the applicable current code been mapped to the procedure performed?
☐ Have payer-specific requirements been reviewed for the new codes?
Before You Submit If 91122 still appears in an active 2026 workflow, review the mapping before submitting claims. This is an educational workflow check, not an automated coding determination. |
5 Places to Check After the 91122 Deletion
Where to Check | What to Look For |
1. EHR / Practice Management System | Check whether 91122 remains selectable. A code that's still clickable will eventually get clicked. |
2. Charge Master | Review code status and mapping so the charge that drops matches an active code. |
3. Superbills | Remove outdated active-code references from paper and digital forms still in circulation. |
4. Internal Coding Guides | Replace 2025 reference sheets -- staff tend to trust the laminated copy over the codebook. |
5. Billing / Clearinghouse Rules | Review current claim-edit configurations and payer requirements against the new codes. |
Note: A CPT deletion is not just a coding-reference change. It becomes a workflow problem when old code mappings remain active across multiple systems.
How an Outdated CPT Code Creates a Claim Problem
Outdated Code Reference | Incorrect Charge Entry | Claim Scrubber / Edit | Rejection or Incorrect Submission | Manual Correction | Delayed Payment |
Not every use of a deleted code produces the same response -- some claims are caught at the clearinghouse, others rejected downstream, and behavior varies by payer and scrubbing configuration. What's consistent is that the correction happens manually, after the fact, and after the clock has started on the claim.
Spot the Problem: The Practice Updated Its CPT Book. Did It Update Everything Else?
Consider a fictional practice that updates its 2026 coding reference on schedule, then discovers 91122 still appears in the EHR, the charge master hasn't been reviewed, an old superbill is still circulating at the front desk, and staff are working from an internal PDF last revised in 2024.
Where would you check first?
Option | Assessment |
A. EHR | A reasonable starting point -- but it's one touchpoint of four. |
B. Charge master | Also reasonable, and closest to where the charge actually originates. |
C. Internal coding guide | Important, but updating it alone leaves the systems unchanged. |
D. All workflow touchpoints | The realistic answer. Each one independently can reintroduce the deleted code. |
Note: A CPT update should be treated as a workflow-wide review rather than a single-reference update. Fixing one touchpoint while three others still carry the old code just changes which system reintroduces the problem. (Scenario is fictional and illustrative.)
2026 Anorectal Manometry Documentation Checklist
Documentation Element | Why It Matters |
Reason for the procedure | Establishes why the study was clinically indicated |
Documented clinical indication | Connects symptoms or condition to the test performed |
Procedure and testing performed | Determines which current code applies -- 91124 or 91125 |
Relevant measurements and findings | Supports that the study was actually completed as billed |
Rectal sensation testing when performed | Part of what 91125 encompasses; documentation should reflect it |
Balloon expulsion testing when performed | Also within the 91125 descriptor when performed |
Interpretation and report | Typically expected for diagnostic studies; verify payer specifics |
Diagnosis information | Supports medical necessity on the claim |
Payer-specific requirements | Coverage, authorization, and frequency rules vary by payer |
Note: Documentation expectations vary by payer and clinical circumstance. This is a review framework, not a list of universal requirements.
Medical Necessity for Anorectal Manometry Billing
Medical necessity runs along a chain: clinical indication, documented condition or symptoms, procedure actually performed, diagnosis coding, and the payer's coverage policy. A weak link anywhere shows up at adjudication.
Requirements vary by payer, MAC, diagnosis, locality, medical policy, and clinical circumstance. There's no universal approved-diagnosis list across payers, and building one from assumption is how practices end up with a pattern of medical necessity denials rather than isolated ones.
How Diagnosis Coding Fits Into the Claim
The diagnosis should reflect the documented condition or the reason the study was performed -- not a code selected because it has historically paid. ICD-10-CM selection should be as specific as the record supports and consistent with the procedure note and interpretation.
The diagnosis, the documentation, and the procedure code should all tell the same clinical story. Where a payer publishes covered-indication guidance, verify it against that payer's current policy rather than assuming another payer's list carries over.
What Billing Teams Should Check Before Submission
Before claims go out under the new codes, confirm current CMS NCCI guidance, payer-specific claim edits, MAC policies, authorization requirements, coverage policies, frequency rules, and documentation requirements. Because 91124 and 91125 are new for 2026, edit behavior around them should be checked directly rather than inferred from how 91120 and 91122 were handled.
Medicare rules don't automatically apply to commercial insurers. Verify specific edits against current published data rather than prior-year claim experience.
10 Anorectal Manometry Billing Mistakes to Watch for in 2026
Mistake | Why It Matters |
Continuing to use deleted CPT 91122 | It is not an active 2026 code for dates of service on or after January 1 |
Failing to update the EHR | An active-looking code in the system will eventually be selected |
Leaving 91122 active in the charge master | The charge drops before anyone reviews the code |
Assuming 91125 is automatically appropriate | 91124 may apply depending on the study performed |
Reporting 91124 and 91125 together | Current guidance directs that they aren't reported together same-day |
Coding from the diagnosis instead of the service | The documented procedure determines the code |
Ignoring current CPT descriptors and parentheticals | The 2026 notes carry reporting instructions worth reading |
Using outdated payer guidance | Payer policy for new codes may differ from prior-code policy |
Submitting without complete documentation | Findings and interpretation support what was billed |
Skipping a post-update workflow audit | The codebook change is the start of the work, not the end |
Before You Submit an Anorectal Manometry Claim
☐ Current 2026 CPT code verified
☐ CPT 91122 is not being used as an active 2026 code
☐ Actual service matches the selected CPT
☐ Documentation supports the service
☐ Diagnosis supports medical necessity
☐ Payer policy reviewed
☐ Authorization checked when applicable
☐ NCCI/edit requirements reviewed
☐ Units/frequency reviewed
☐ Claim information matches the medical record
60-Second Claim Check One outdated code can create a workflow problem. A short pre-submission review catches it earlier. |
How Much Does Anorectal Manometry Reimburse in 2026?
There's no single reimbursement amount that applies across practices. Payment depends on the payer, Medicare vs. commercial, locality, contracted rate, place of service, coverage policy, modifiers where applicable, and the specific claim circumstances.
Because 91124 and 91125 are new for 2026, verify their values directly rather than estimating from the deleted codes' historical rates. Check the current Medicare rate for your locality through the CMS Physician Fee Schedule lookup tool, and commercial allowed amounts against the applicable contract.
How to Prevent 91122-Related Billing Problems
Step | What Happens Here |
CPT Update | Apply the 2026 code set -- the starting point, not the finish line |
EHR Review | Confirm deleted codes are no longer selectable |
Charge Master Review | Verify code status and mapping at the source of the charge |
Code Mapping | Map each service performed to the correct current code |
Documentation Review | Confirm the record supports the code selected |
Payer Policy Check | Review coverage and requirements for the new codes |
Claim Scrubbing | Catch outdated references before submission |
Submission | Send claims that match both the record and the current code set |
ERA/EOB Review | Read remittances, including on paid claims |
Denial/Underpayment Follow-Up | Address the actual reason and look for recurring patterns |
When Coding Changes Become an RCM Issue
A coding update becomes a revenue-cycle issue when outdated information survives inside the workflow. The deletion is simple to understand; the downstream effects reach charge capture, clean claim rates, submission, rejection management, denial prevention, payment posting, A/R, and reporting accuracy.
Sirius Solutions Global is a Dallas-based Revenue Cycle Management company supporting healthcare organizations with medical billing, claims management, denial management, A/R management, payment posting, billing workflow review, credentialing and provider enrollment, and revenue-cycle support. A code deletion is exactly the kind of change where the coding answer is straightforward and the workflow answer takes a structured review.
More about Sirius Solutions Global's revenue-cycle services.
Frequently Asked Questions
Is CPT 91122 deleted in 2026?
Yes. CPT 91122 was deleted effective January 1, 2026, and is not an active code for dates of service on or after that date.
When was CPT 91122 deleted?
January 1, 2026, as part of the 2026 CPT code set. CPT 91120 was deleted at the same time.
What changed with CPT 91122 in 2026?
91120 and 91122 were replaced by two new Category I codes -- 91124 and 91125 -- that draw a clearer line between barostat testing and anorectal manometry.
What is CPT 91125?
Anorectal manometry, with rectal sensation and rectal balloon expulsion test when performed. The sensation and expulsion components are included rather than reported separately.
Is CPT 91125 the replacement for CPT 91122?
It's the closest successor for anorectal manometry, but not an automatic one-for-one substitute. 91124 may apply depending on the study performed -- the documented service determines the code.
Can 91124 and 91125 be billed together?
Current CPT guidance directs that these are not reported together on the same date of service.
What documentation should support anorectal manometry billing?
The clinical indication, the specific testing performed, relevant measurements and findings, the interpretation and report, and a diagnosis supporting medical necessity.
Does Medicare cover anorectal manometry?
Coverage depends on medical necessity, documentation, and the applicable Medicare or MAC policy -- it isn't automatic. Verify current requirements directly.
How can practices update their workflow after a CPT deletion?
Audit the EHR, charge master, superbills, internal coding guides, and clearinghouse/claim-edit rules -- not just the coding reference.
2026 Coding References
• AMA -- CPT 2026 code set and CPT Assistant guidance on the deletion of 91120/91122 and establishment of 91124/91125
• American Gastroenterological Association -- 2026 motility coding changes and neurogastroenterology coding FAQs
• CMS -- Medicare Physician Fee Schedule lookup tool and National Correct Coding Initiative (NCCI) resources
• Applicable Medicare Administrative Contractor (MAC) -- Local Coverage Determinations and billing guidance for anorectal testing
Disclaimer
This article is provided for general educational and informational purposes and does not replace current CPT instructions, payer policies, Medicare guidance, or professional coding advice. Coding, coverage, and reimbursement requirements can change and vary by payer, MAC, locality, and clinical circumstance -- verify current requirements applicable to the specific claim and payer before submission. Sirius Solutions Global makes no guarantee regarding claim approval, coverage, or reimbursement outcomes. CPT is a registered trademark of the American Medical Association.
