CPT 91117 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 91117 by major payers:
$199.93
$185.09
$178.99
$234.41
| 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 91117 | ||||||
United | 91117 | $1143.00 | 1205189172 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL OVERLOOK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 91117 | $1492.00 | 1588870737 - METROHEALTH MEDICAL CENTER | 346004382 | OH | General Acute Care Hospital (282N00000X) |
United | 91117 | $1632.00 | 1538524061 - DEARBORN COUNTY HOSPITAL | 610445850 - ST ELIZABETH MEDICAL CENTER INC | IN | General Acute Care Hospital (282N00000X) |
United | 91117 | $3439.00 | 1285200105 - MEDICAL UNIVERSITY HOSPITAL AUTHORITY, MUSC HEALTH COLUMBIA MEDICAL CENTER NORTHEAST | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 91117 | $3961.00 | 1235134024 - VIRTUA OUR LADY OF LOURDES HOSPITAL INC, VIRTUA OUR LADY OF LOURDES HOSPITAL | 210635001 - (NJ) VIRTUA OUR LADY OF LOURDES HOSPITAL INC | NJ | General Acute Care Hospital (282N00000X) |
United | 91117 | $565.00 | 1225128432 - UNIVERSITY HOSPITALS GENEVA MEDICAL CENTER, THE MEMORIAL HOSPITAL OF GENEVA | 340714461 - (OH) UNIVERSITY HOSPITALS HEALTH SYSTEM INC | OH | Critical Access Hospital (282NC0060X) |
United | 91117 | $817.00 | 1023061496 - CRESTWOOD HEALTHCARE LP, CRESTWOOD MEDICAL CENTER | 621647983 | AL | General Acute Care Hospital (282N00000X) |
United | 91117 | $2328.00 | 1689624686 - DENVER HEALTH AND HOSPITAL AUTHORITY | 841343242 | CO | General Acute Care Hospital (282N00000X) |
United | 91117 | $950.00 | 1992953525 - SHARKEY-ISSAQUENA COMMUNITY HOSPITAL | 640650533 - (MS) SHARKEY ISSAQUENA COMMUNITY HOSPITAL | MS | General Acute Care Hospital (282N00000X) |
United | 91117 | $7763.00 | 1740215219 - JOHN MUIR HEALTH, JOHN MUIR HEALTH, WALNUT CREEK MEDICAL CENTER | 941461843 - (CA) JOHN MUIR HEALTH | CA | General Acute Care Hospital (282N00000X) |
United | 91117 | $442.00 | 1487640207 - DISTRICT HOSPITAL PARTNERS L P, THE GEORGE WASHINGTON UNIVERSITY HOSPITAL | 232896725 | DC | General Acute Care Hospital (282N00000X) |
United | 91117 | $1204.00 | 1942247044 - CENTERPOINT MEDICAL CENTER OF INDEPENDENCE, LLC | 450503121 - (MO) CENTERPOINT MEDICAL CENTER OF INDEPENDENCE LLC | MO | General Acute Care Hospital (282N00000X) |
United | 91117 | $940.91 | 1558148627 - INTEGRIS HEALTH WOODWARD HOSPITAL INC, INTEGRIS HEALTH WOODWARD HOSPITAL | 932826081 | OK | General Acute Care Hospital (282N00000X) |
United | 91117 | $1094.00 | 1093009151 - USC UNIVERSITY HOSPITAL | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | General Acute Care Hospital (282N00000X) |
United | 91117 | $310.00 | 1801814629 - FRANK T RUTHERFORD MEMORIAL HOSPITAL, INC, RIVERVIEW REGIONAL MEDICAL CENTER SOUTH | 621762469 | TN | Critical Access Hospital (282NC0060X) |
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 91117 vs. Other Gastroenterology Procedures Codes
The CPT 91117 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 91117 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 |
|---|---|---|
| 91117-CPT | Low | Colon Motility (Manometric) Study, Minimum 6 Hours Continuous Recording (Including Provocation Tests, Eg, Meal, Intracolonic Balloon Distension, Pharmacologic Agents, If Performed), With Interpretation And Report |
| 91120-CPT | Moderate | Rectal Sensation, Tone, And Compliance Test (Ie, Response To Graded Balloon Distention) |
| 91122-CPT | Moderate | Anorectal Manometry |
| 91132-CPT | Moderate | Electrogastrography, Diagnostic, Transcutaneous |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 91117. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91117 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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