CPT 91314 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 • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • SL • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Moderate |
National average reimbursement for CPT 91314 by major payers:
$0.00
$0.01
$N/A
$0.07
| 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 91314 | ||||||
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CPT 91314 vs. Other Gastroenterology Procedures Codes
The CPT 91314 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 91314 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 |
|---|---|---|
| 91312 | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Mrna-Lnp, Bivalent Spike Protein, Preservative Free, 30 Mcg/0.3 Ml Dosage, Tris-Sucrose Formulation, For Intramuscular Use |
| 91313 | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Mrna-Lnp, Spike Protein, Bivalent, Preservative Free, 50 Mcg/0.5 Ml Dosage, For Intramuscular Use |
| 91314 | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Mrna-Lnp, Spike Protein, Bivalent, Preservative Free, 25 Mcg/0.25 Ml Dosage, For Intramuscular Use |
| 91315 | Low | Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease (Covid-19)) Vaccine, Mrna-Lnp, Bivalent Spike Protein, Preservative Free, 10 Mcg/0.2 Ml Dosage, Diluent Reconstituted, Tris-Sucrose Formulation, 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 91314. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91314 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
|---|