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See a sample rate comparisonCPT 91318 Fee Schedule
Last Verified: October 2026
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.
Sarscov2 Vac 3mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 3 Mcg 0 3 Ml Dosage Tris Sucrose Formulation For Intramuscular Use
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Gastroenterology Procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 91318 |
| Medicaid Fee Schedule | $65.36 median of the 8 states in the free preview · View Medicaid rates for 91318 |
National average reimbursement for CPT 91318 by major payers:
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CPT 91318
5 of 25 sample ratesHigher to lower in this preview
Hossam Abdelsalam
Siu Physicians & Surgeons Inc
$109.25Published rateAdam Wallace
Rockford Health Physicians
$75.90Published rateKapil Aedma
Swope Health Services
$67.84Published rateAlyssa Stram
$64.40Published rateOday Alsarraf
Swedishamerican Hospital
$57.50Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 91318 vs. Other Gastroenterology Procedures Codes
The CPT 91318 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 91318 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 |
|---|---|---|
| 91318-CPT | Moderate | Sarscov2 Vac 3mcg Trs Suc Im, Severe Acute Respiratory Syndrome Coronavirus 2 Sarscov 2 Coronavirus Disease Covid 19 Vaccine Mrnalnp Spike Protein 3 Mcg 0 3 Ml Dosage 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 91318. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91318 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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