CPT 91111 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Gastroenterology Procedures |
| Common Place of Service | • 11 - Office • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
National average reimbursement for CPT 91111 by major payers:
$957.85
$1,032.88
$1,014.00
$1,376.68
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 91111 | ||||||
United | 91111 | $75.98 | 1265446025 - MATTHEW KNECHT | 134352061 | OR | Optometrist (152W00000X) |
United | 91111 | $1154.05 | 1760429831 - BRUCE MADSEN | 930590581 - EYECARE ASSOCIATES PC | OR | Ophthalmology Physician (207W00000X) |
United | 91111 | $2809.00 | 1174973267 - UNIVERSITY MEDICAL CENTER MEDICAL CENTER IN PLAINSBORO | 210635009 - PRINCETON HEALTHCARE SYSTEM A NEW JERSEY NON-PROFIT CORP | NJ | General Acute Care Hospital (282N00000X) |
United | 91111 | $3287.00 | 1881977593 - DLP PERSON MEMORIAL HOSPITAL LLC, PERSON MEMORIAL HOSPITAL | 452909143 | NC | General Acute Care Hospital (282N00000X) |
United | 91111 | $1697.00 | 1376591941 - HOSPITAL SERVICE DISTRICT 1 OF EAST BATON ROUGE PARISH, LANE REGIONAL MEDICAL CENTER | 726015227 | LA | General Acute Care Hospital (282N00000X) |
United | 91111 | $1678.00 | 1447303227 - GULF HEALTH HOSPITALS, INC, THOMAS HOSPITAL | 630891904 - (AL) GULF HEALTH HOSPITALS INC | AL | General Acute Care Hospital (282N00000X) |
United | 91111 | $804.96 | 1174528517 - CAT SCAN CENTRE | 760469796 - (TX) CAT SCAN CENTRE | TX | Radiology Clinic/Center (261QR0200X) |
United | 91111 | $1175.00 | 1932646049 - SCOTT COUNTY COMMUNITY HOSPITAL, INC., BIG SOUTH FORK MEDICAL CENTER | 814896412 - (TN) SCOTT COUNTY COMMUNITY HOSPITAL INC | TN | Critical Access Hospital (282NC0060X) |
United | 91111 | $4230.00 | 1912314162 - HOLY NAME MEDICAL CENTER INC. | 221487322 - (NJ) HOLY NAME MEDICAL CENTER INC | NJ | General Acute Care Hospital (282N00000X) |
United | 91111 | $5005.00 | 1154399749 - OHI WEST, INC, BAYFRONT HEALTH ST PETERSBURG | 845074208 - (FL) OHI WEST INC | FL | General Acute Care Hospital (282N00000X) |
United | 91111 | $713.90 | 1679523708 - DIAGNOSTIC CLINIC OF ATHENS,LLC, ATHENS DIAGNOSTIC CENTER | 582588390 | GA | Radiology Clinic/Center (261QR0200X) |
United | 91111 | $2736.00 | 1154703296 - WICKED HEIGHTS MEDICAL CENTER | 111631837 - (NY) WYCKOFF HEIGHTS MEDICAL CENTER | NY | General Acute Care Hospital (282N00000X) |
United | 91111 | $5523.00 | 1528064409 - VIRTUA | 210634532 - VIRTU-WEST JERSEY HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 91111 | $2659.00 | 1013010917 - COMMUNITY MEDICAL CENTER INC | 223452306 | NJ | General Acute Care Hospital (282N00000X) |
United | 91111 | $1586.00 | 1538667035 - CARTHAGE HOSPITAL, LLC | 824005981 | TX | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 91111 vs. Other Gastroenterology Procedures Codes
The CPT 91111 code is part of the Medicine Services and Procedures services used for Gastroenterology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 91111 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 91010-CPT | Moderate | Esophageal Motility (Manometric Study Of The Esophagus And/Or Gastroesophageal Junction) Study With Interpretation And Report; 2-Dimensional Data |
| 91013-CPT | Low | Esophageal Motility (Manometric Sturdy Of The Esophagus And/Or Gastroesophageal Junction) Study With Interpretation And Report; With Stimulation Or Perfusion During 2-Dimensional Data Study (Eg Stimulant Acid Or Alkali Perfusion)(List Separately In Addition To Code For Primary Procedure) |
| 91110-CPT | Moderate | Gastrointestinal Tract Imaging Intraluminal (Eg Capsule Endoscopy) Esophagus Through Ileum With Interpretation And Report (Revised 1/1/2013) |
| 91111-CPT | Moderate | Gastrointestinal Tract Imaging Intraluminal (Eg Capsule Endoscopy) Esophagus With Interpretation And Report (Revised 1/1/2013) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 91111. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91111 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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