CPT code 91111: Capsule imaging, esophagus only2026 Medicare rate & RVUs in California
Reports capsule-based imaging limited to the esophagus, including the technical study and interpretation when performed as a complete service.
Medicare pays $1,045.54–$1,368.63 for 91111 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 91111 covers
A patient swallows a miniature camera capsule that captures images as it passes through the esophagus. Gastroenterologists typically use this approach to assess the esophageal lining, including when capsule-based evaluation of suspected mucosal abnormalities or varices is selected. The study may be performed in an outpatient setting, with the patient wearing equipment that records the images for later review.
Report 91111 when the capsule imaging study is limited to the esophagus; use the documented study extent to distinguish it from imaging that covers additional gastrointestinal regions. The record should support the reason for the study, the esophageal imaging performed, and the resulting interpretation. CMS recognizes professional and technical components: modifier 26 identifies interpretation, modifier TC identifies equipment and staff, and billing without either modifier represents the global service.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 91111 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$1045.54 to $1368.63
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $1,045.73 | Unavailable |
| Chico, CA | $1,045.54 | Unavailable |
| El Centro, CA | $1,045.55 | Unavailable |
| Fresno, CA | $1,045.54 | Unavailable |
| Hanford, CA | $1,045.54 | Unavailable |
| Los Angeles, CA | $1,127.01 | Unavailable |
| Madera, CA | $1,045.54 | Unavailable |
| Marin County, CA | $1,338.43 | Unavailable |
| Merced, CA | $1,045.54 | Unavailable |
| Modesto, CA | $1,045.54 | Unavailable |
| Napa, CA | $1,252.39 | Unavailable |
| Oxnard, CA | $1,125.64 | Unavailable |
| Redding, CA | $1,045.54 | Unavailable |
| Rest of California | $1,045.54 | Unavailable |
| Riverside, CA | $1,046.10 | Unavailable |
| Sacramento, CA | $1,108.14 | Unavailable |
| Salinas, CA | $1,104.29 | Unavailable |
| San Benito County, CA | $1,368.63 | Unavailable |
| San Diego, CA | $1,138.52 | Unavailable |
| San Francisco, CA | $1,338.38 | Unavailable |
| San Luis Obispo, CA | $1,085.36 | Unavailable |
| Santa Clara County, CA | $1,368.40 | Unavailable |
| Santa Cruz, CA | $1,155.84 | Unavailable |
| Santa Maria, CA | $1,110.68 | Unavailable |
| Santa Rosa, CA | $1,168.14 | Unavailable |
| Stockton, CA | $1,045.54 | Unavailable |
| Vallejo, CA | $1,252.31 | Unavailable |
| Visalia, CA | $1,045.54 | Unavailable |
| Yuba City, CA | $1,045.54 | Unavailable |
How the 91111 rate is calculated
Each of 91111’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 91111
RVUs × geographic indexes × conversion factor
Work0.88
0.88 RVUs× 1.000 GPCI
Practice expense27.72
27.72 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
28.6500
Conversion factor
$33.4009
Medicare rate
$956.94
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 91111
The CMS indicators that decide how 91111 is paid alongside other services.
CMS payment indicators · 91111
Capsule imaging, esophagus only
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
91111 without 26 · national office
$956.94
Capsule imaging, esophagus only
91111-26 · Professional component
$47.76
Pays only the interpretation and report.
91111 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 91110Capsule imagingEsophagus through ileum
- Choose 91111 when the capsule study is limited to the esophagus. Choose 91110 when the study extends through the gastrointestinal tract to the ileum.
- 91113Colon capsule imagingColon segment
- 91113 reports capsule imaging of the colon; 91111 reports imaging limited to the esophagus.
- 91112Motility capsuleTransit and pressure measurement
- 91112 measures gastrointestinal transit and pressure using a wireless capsule. It is a physiologic study, not capsule imaging of esophageal mucosa.
- 43200EsophagoscopyFlexible scope with brushings
- 43200 is direct flexible esophagoscopy. It uses an endoscope for visual examination, while 91111 uses images captured by a swallowed capsule.
91111 billing questions
How does 91111 differ from 91110?
91111 is for capsule imaging limited to the esophagus. 91110 covers a broader examination extending from the esophagus through the ileum.
When should modifier 26 or TC be reported?
Use modifier 26 for the professional interpretation and modifier TC for the technical service, including equipment and staff. Report the global service without either modifier when billing both components together.
Does 91111 include the image interpretation?
The professional component represents the interpretation. When billed globally, the service includes both the technical component and professional interpretation.
Should each capsule image be billed as a separate unit?
No. The code represents the esophageal capsule imaging study, not individual captured images.
What documentation supports reporting 91111?
Document the clinical reason, that capsule imaging was limited to the esophagus, and the study findings and interpretation. The documented extent helps distinguish 91111 from broader gastrointestinal capsule imaging.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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