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 | $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 | $693.00 | 1255995361 - VHS OF PHOENIX INC, ABRAZO MESA HOSPITAL | 621809851 | AZ | General Acute Care Hospital (282N00000X) |
United | 91117 | $399.00 | 1861554438 - UNIVERSITY MEDICAL CENTER, INC, DBA UNIVERSITY OF LOUSIVILLE HOSPITAL | 611293786 - (KY) UNIVERSITY MEDICAL CENTER INC | KY | General Acute Care Hospital (282N00000X) |
United | 91117 | $4426.00 | 1710333893 - THEDACARE MEDICAL CENTER, RIVERSIDE MEDICAL CENTER, INC. | 350983617 - COMMUNITY HEALTH NETWORK INC | WI | Critical Access Hospital (282NC0060X) |
United | 91117 | $1789.00 | 1275578064 - AURORA MEDICAL CENTER OF OSHKOSH, INC | 391027676 - AURORA HEALTH CARE INC | WI | General Acute Care Hospital (282N00000X) |
United | 91117 | $4462.00 | 1033224704 - UNIVERSITY HOSPITAL AT STONY BROOK, STONY BROOK SOUTHAMPTON HOSPITAL | 113243405 | NY | General Acute Care Hospital (282N00000X) |
United | 91117 | $862.00 | 1821026816 - EAST COOPER COMMUNITY HOSPITAL, INC., EAST COOPER MEDICAL CENTER | 934555562 | SC | General Acute Care Hospital (282N00000X) |
United | 91117 | $2929.00 | 1104981661 - DIGNITY HEALTH, MERCY HOSPITAL | 951642380 | CA | General Acute Care Hospital (282N00000X) |
United | 91117 | $695.00 | 1730761065 - BURKE HOSPITAL COMPANY, BURKE HEALTH | 853939331 - BURKE HOSPITAL COMPANY, LLC | GA | 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 | $1400.00 | 1417037045 - MOUNT CARMEL HEALTH SYSTEM | 311439334 - MOUNT CARMEL HEALTH SYSTEM | OH | General Acute Care Hospital (282N00000X) |
United | 91117 | $796.21 | 1902832306 - THEDACARE REGIONAL MEDICAL CENTER, APPLETON MEDICAL CENTER,INC. | 390824015 - (WI) THEDACARE REGIONAL MEDICAL CENTER- APPLETON INC | WI | General Acute Care Hospital (282N00000X) |
United | 91117 | $504.00 | 1750399192 - MARYVIEW HOSPITAL LLC, BON SECOURS MARYVIEW MEDICAL CENTER | 540506463 | VA | 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 | $497.00 | 1134128911 - COLUMBIA COUNTY HOSPITAL DISTRICT, DAYTON GENERAL HOSPITAL | 910741968 | WA | 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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