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See a sample rate comparisonCPT 91111 Fee Schedule
Last Verified: October 2026
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.
Imaging Of Digestive Tract, Images Of The Digestive Tract With A Report Of Results. The Test Involves Swallowing A Tiny Capsule Containing A Camera For Viewing The Inside Of The Digestive Tract From The Esophagus Through The Intestines.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Gastroenterology Procedures |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | 26 - Professional component TC - Technical component |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $956.94 national non-facility rate (2026) · View Medicare rates for 91111 |
| Medicaid Fee Schedule | $759.375 median of the 8 states in the free preview · View Medicaid rates for 91111 |
National average reimbursement for CPT 91111 by major payers:
$957.85
$1,032.88
$1,014.00
$1,343.38
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CPT 91111
5 of 25 sample ratesHigher to lower in this preview
Our Lady Of Lourdes Regional Medical Center,Inc
Our Lady Of Lourdes Regional Medical Center Inc
$7,252.00Published rateChippenham & Johnston-Willis Hospitals Inc, Cjw Medical Center
$3,340.00Published rateJackson Hospital & Clinic, Inc., Jackson Hospital & Clinic, Inc.
Jackson Hospital & Clinic Inc
$2,131.00Published rateCovington County Hospital
$1,305.00Published rateCt Center Of Flint, PLLC, Premier Imaging Centers
Ct Center Of Flint PLLC
$44.09Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 91110-CPT | Moderate | Imaging Of Digestive Tract, Images Of The Digestive Tract With A Report Of Results. The Test Involves Swallowing A Tiny Capsule Containing A Camera For Viewing The Inside Of The Digestive Tract From The Esophagus Through The Intestines. |
| 91111-CPT | Moderate | Imaging Of Digestive Tract, Images Of The Digestive Tract With A Report Of Results. The Test Involves Swallowing A Tiny Capsule Containing A Camera For Viewing The Inside Of The Digestive Tract From The Esophagus Through The Intestines. |
| 91112-CPT | High | High Tech Study Of Intestines, A Gastric Transit Study Measures Temperature Pressure And Ph From The Stomach Through The Intestines. A Capsule With Miniature Electronics Is Swallowed And Sends Signals To An External Recorder While It Moves Through The Digestive System. |
| 91113-CPT | High | Gi Tract Imaging Intraluminal Colon I&R, Gastrointestinal Tract Imaging Intraluminal (Eg Capsule Endoscopy) Colon With Interpretation And Report |
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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