CPT 91311 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 • 20 - Urgent Care Facility |
| Common Modifiers | • None • SL • SE - Scene to Residential facility |
| Complexity Level | Low |
National average reimbursement for CPT 91311 by major payers:
$1.41
$0.01
$N/A
$0.02
| 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 91311 | ||||||
United | 91311 | $0.01 | 1912282948 - IMRAN KHALIL | 630739971 - (AL) CARDIOLOGY ASSOCIATES, P.A. | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91311 | $0.01 | 1386085793 - ASHWINI SHARMA | 203204949 - THE HEALTH CARE AUTHORITY FOR BAPTIST HEALTH, AN AFF OF UAB HLTH SYSTM | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91311 | $0.01 | 1033320049 - ANN STECK | 10877201 | OH | Family Medicine Physician (207Q00000X) |
United | 91311 | $0.02 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | 91311 | $0.01 | 1073530523 - DAVID KIM | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Interventional Pain Medicine Physician (208VP0014X) |
United | 91311 | $0.01 | 1124385927 - CHAD MCREE | 561667838 | NC | Interventional Cardiology Physician (207RI0011X) |
United | 91311 | $0.02 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 91311 | $0.01 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 91311 | $0.01 | 1730385618 - CABRINI SUTHERLAND | 561026666 - SURGICAL SPECIALISTS OF CHARLOTTE, PA | NC | Surgical Critical Care Physician (2086S0102X) |
United | 91311 | $0.01 | 1992948046 - JACQUELINE GREEN | 260593928 | AL | Interventional Cardiology Physician (207RI0011X) |
United | 91311 | $0.01 | 1366428401 - AARON ASKEW | 931224010 - PRAXIS HEALTH, P.C. | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 91311 | $0.02 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | 91311 | $0.01 | 1063490845 - KEVIN SCHLESSEL | 311425166 - COLUMBUS ARTHRITIS CENTER | OH | Rheumatology Physician (207RR0500X) |
United | 91311 | $0.01 | 1780694620 - CARSON MEDICAL GROUP PROFESSIONAL CORPORATION | 880133501 - CARSON MEDICAL GROUP | NV | Obstetrics & Gynecology Physician (207V00000X) |
United | 91311 | $0.01 | 1912282948 - IMRAN KHALIL | 630739971 - (AL) CARDIOLOGY ASSOCIATES, P.A. | AL | Interventional Cardiology Physician (207RI0011X) |
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 91311 vs. Other Gastroenterology Procedures Codes
The CPT 91311 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 91311 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 |
|---|---|---|
| 91300-CPT | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 30 Mcg/0.3 Ml Dosage, Diluent Reconstituted, For Intramuscular Use |
| 91306-CPT | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 50 Mcg/0.25 Ml Dosage, For Intramuscular Use |
| 91309-CPT | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 50 Mcg/0.5 Ml Dosage, For Intramuscular Use. |
| 91311-CPT | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 25 Mcg/0.25 Ml Dosage, For Intramuscular Use |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 91311. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91311 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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