CPT 91112 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | High |
National average reimbursement for CPT 91112 by major payers:
$1,722.65
$1,727.30
$1,828.70
$2,402.72
| 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 91112 | ||||||
United | 91112 | $1043.36 | 1972537397 - DARRYL HAMILTON | 630047680 - (AL) COMMUNITY HOSPITAL INC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91112 | $4750.41 | 1225211600 - JOHN MILLICHAP | 800863895 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91112 | $131.27 | 1679739148 - THANH THAI | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 91112 | $2546.58 | 1992234611 - USHA APPALANENI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91112 | $163.74 | 1710914890 - ADNAN ARIF | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 91112 | $2637.78 | 1881918415 - TUSHAR ADVANI | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 91112 | $2285.58 | 1912282948 - IMRAN KHALIL | 61330992 - NORTHEAST MEDICAL GROUP INC | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91112 | $116.91 | 1477588408 - TIMOTHY LEE | 452803595 - (AL) ALABAMA HEART AND VASCULAR, P.C. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91112 | $2769.79 | 1609239243 - MEGAN GINSBURG | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 91112 | $2005.23 | 1720243025 - SAMEEN AHMAD | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 91112 | $2459.11 | 1356723811 - VICTOR PATRON ROMERO | 911780074 | IL | Psychiatry Physician (2084P0800X) |
United | 91112 | $197.44 | 1225211600 - JOHN MILLICHAP | 460319070 - MONUMENT HEALTH RAPID CITY HOSPITAL INC | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91112 | $1460.64 | 1801835202 - CHICAGO NEUROLOGY GROUP SC | 113666848 - (IL) CHICAGO NEUROLOGY GROUP, S.C. | IL | Psychiatry Physician (2084P0800X) |
United | 91112 | $3656.92 | 1104230036 - AFSANEH TALAI | 756002868 | TX | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 91112 | $2112.27 | 1871907774 - ODAY ALSARRAF | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
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 91112 vs. Other Gastroenterology Procedures Codes
The CPT 91112 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 91112 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) |
| 91112-CPT | High | Gastrointestinal Transit And Pressure Measurement Stomach Through Colon Wireless Capsule 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 91112. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91112 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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