Neurogastroenterology and Motility FAQs (Coding & CPT Updates Guide)

Neurogastroenterology and motility testing are changing how procedures get documented and reimbursed. That shift is already affecting claims. CPT updates are coming, but with code deletions and newly bundled services changing the structure due to which accurate coding becomes harder to get right.

Here are the answers of relevant FAQs that covers motility procedure coding, CPT changes, and device-based therapies like IB-Stim™. New code structures, reporting rules, and billing scenarios are all addressed to help providers maintain compliance in gastroenterology medical billing.

CPT Code Changes & Deletions (Updates)

CPT updates bring key changes to gastroenterology medical billing. Outdated codes are removed, but with better coding accuracy as the direct result. Duplicate reporting gets reduced across the board. Coding aligns more closely with current motility practices.

Why were CPT codes 91120 and 91122 deleted?

CPT codes 91120 and 91122 were deleted due to a co-billing rate of over 75%. They were almost always reported together, causing overlapping services and duplicate reporting.

In April 2023, the AMA Relative Value Scale Update Committee (RUC) identified this issue and recommended creating a bundled coding structure to improve accuracy. 

Major GI organizations, like the American Neurogastroenterology and Motility Society, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and American College of Gastroenterology had collaborated to update the code structure and physician work descriptions.

This now removes duplicate coding and allows more accurate reporting of the current motility procedures.

New CPT Codes Replacing 91120 & 91122

These updates in gastroenterology medical billing introduce a more structured approach to reporting anorectal motility procedures by replacing previously overlapping codes with clearly defined services.

What codes replace 91120 and 91122 starting in 2026?

From January 1, 2026, the following Category I CPT codes replace 91120 and 91122: 

• 91124 – Rectal sensation, tone, and compliance study (e.g., barostat)
• 91125 – Anorectal manometry, including rectal sensation and balloon expulsion test, when performed

Purpose:

• Eliminate duplicative reporting
• Improve coding accuracy and clarity

Coding Restrictions for New Motility Codes

Accurate reporting of new motility CPT codes is essential in gastroenterology medical billing to avoid compliance issues and claim denials.

Can CPT codes 91124 and 91125 be reported together on the same day?

No because as CPT guidelines specify 91124 and 91125 cannot be billed for the same patient on the same day.

This restriction helps:

• Prevent duplicate billing
• Properly report procedures
• Adhere to new coding guidelines 

IB-Stim™ Device & PENFS Coding

The use of non-implanted percutaneous electrical nerve field stimulation (PENFS), such as IB-Stim™, is an emerging therapy in pediatric gastroenterology for patients with functional abdominal pain related to IBS or functional dyspepsia, particularly after failure of standard pharmacologic treatment.

What CPT code is used when starting IB-Stim™ therapy in pediatric IBS patients after failed medical management?

IB-Stim™ is an FDA-approved non-implanted neurostimulator device used in patients aged 8–21 years with functional abdominal pain associated with irritable bowel syndrome (IBS) and/or functional dyspepsia with nausea, typically after appropriate medical therapy has been tried and found ineffective.

This procedure is defined as percutaneous placement of an external electrical nerve field stimulator (PENFS) device, including stimulation of the branches of the cranial nerve field via periauricular placement without implantation. 

This procedure is reported as using for:

• CPT Code 64567 – Percutaneous electrical nerve field stimulation, cranial nerves, without implantation. 

This brings gastroenterology medical billing claims coding into line with current practice, ensuring accurate coding and reimbursement for PENFS-based therapies.

Frequency of Reporting PENFS (IB-Stim™) Code

PENFS therapy using IB-Stim™ is typically delivered as a structured short-term treatment course, where devices are placed on a scheduled basis to achieve therapeutic effect in pediatric patients with functional abdominal pain related to IBS.

Can CPT code 64567 be reported multiple times during PENFS (IB-Stim™) treatment?

Yes. PENFS treatment is commonly administered over a four-week protocol, with a new non-implanted device placed once per week for four consecutive weeks, depending on the treatment plan.

Each application represents a separate service, and therefore:

• CPT 64567 may be reported for each individual device placement
• Each session is considered a distinct, billable encounter when performed as part of the treatment cycle
• Clear documentation mentioning weekly placement and medical necessity

E/M Billing with PENFS Procedures

Proper handling of Evaluation and Management (E/M) services alongside PENFS (IB-Stim™) therapy is important in gastroenterology medical billing to avoid duplicate reporting and ensure compliance with CPT guidelines.

Can an E/M visit be billed on the same day as PENFS device placement?

In most cases, it is not typical to report a separate E/M service on the same day as CPT 64567 because the clinical decision to initiate PENFS therapy is generally made during a prior visit. On the day of device placement, only a brief assessment of patient tolerance, response, or immediate complications is considered part of the procedural work and is included in the value of CPT 64567.

However, an E/M service may be separately reportable in specific situations, such as:

• The patient is newly referred specifically for PENFS evaluation and decision-making is performed on the same day
• There is a significant time gap between the initial treatment decision and the actual device placement
• Additional extended evaluation and medical decision-making is required on the same visit
• The final treatment session includes formal reassessment and planning of next steps

In these circumstances, CPT 64567 may be reported along with an appropriate E/M code, provided that documentation clearly supports a separately identifiable service.

Billingfreedom Delivers 99% Coding Accuracy With 97% Claim Acceptance And Just 1% Denial Rate In Gastroenterology Medical Billing

CPT updates hit neurogastroenterology and motility coding badly. Bundled studies, PENFS therapy under 64567, and updated manometry codes 91124 and 91125 all require precise reporting. While billing and coding one misstep means duplication, coding errors, or reimbursement delays. Payers will not give the benefit of the doubt.

BillingFreedom stays current with every CPT structure change. Claims go out aligned with updated coding standards, but with compliance and accurate reimbursement as the outcome every time.

Our expert billing framework is designed to maintain:

• 99.1% coding accuracy
• 97.6% first-pass claim acceptance rate
• Denial rate controlled at 1%

These outcomes are achieved through strict validation of CPT 2026 updates, correct modifier application, and enforcement of payer-specific rules.

Eliminating inconsistencies in code selection and enhancing the accuracy of claims, BillingFreedom can deliver up to 70% greater efficiency in revenue realization by cutting down on rework, faster claim approvals and optimized reimbursement cycles for healthcare providers.

To learn more about our outstanding Gastroenterology medical billing solutions, then please do not delay to reach us through email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

Your financial peace is what matters to us!