CPT code 91113: Colon capsule imaging, colon segment2026 Medicare rate & RVUs in New York
Reports capsule-based imaging of the colon when a clinician reviews the recorded images and documents an interpretation and report.
Medicare pays $939.16–$1,163.97 for 91113 in the office in New York, from Rest of New York to NYC suburbs and Long Island, NY. 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.
Your location
On this page 9 sections
What 91113 covers
A swallowed imaging capsule records views of the colon as it passes through the gastrointestinal tract. A gastroenterologist or other qualified physician reviews the recorded images and prepares the interpretation; technical staff may support capsule administration and image capture. The study may be selected when a capsule-based examination is used to assess colonic mucosa, including after an incomplete conventional colonoscopy or when that examination cannot be completed.
Report 91113 for the colon portion of capsule imaging, not for an esophageal or small-bowel study. Documentation should identify the colon capsule examination, support that images were acquired, and include the physician’s interpretation and report. CMS recognizes professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies the equipment and staff service, and reporting without a component 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 91113 pays more and less in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
5 payment localities
$939.16 to $1163.97
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $1,138.67 | Unavailable |
| NYC suburbs and Long Island, NY | $1,163.97 | Unavailable |
| Poughkeepsie and northern NYC suburbs, NY | $1,075.39 | Unavailable |
| Queens, NY | $1,156.26 | Unavailable |
| Rest of New York | $939.16 | Unavailable |
How the 91113 rate is calculated
Each of 91113’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 · 91113
RVUs × geographic indexes × conversion factor
Work2.35
2.35 RVUs× 1.000 GPCI
Practice expense27.05
27.05 RVUs× 1.000 GPCI
Malpractice0.10
0.10 RVUs× 1.000 GPCI
Adjusted RVUs
29.5000
Conversion factor
$33.4009
Medicare rate
$985.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 91113
The CMS indicators that decide how 91113 is paid alongside other services.
CMS payment indicators · 91113
Colon capsule imaging, colon segment
| 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
91113 without 26 · national office
$985.33
Colon capsule imaging, colon segment
91113-26 · Professional component
$127.26
Pays only the interpretation and report.
91113 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 91110Capsule imagingEsophagus through ileum
- Use 91113 for colon capsule imaging and 91110 for small-intestine capsule imaging; the examined segment determines the code.
- 91111Capsule imagingEsophagus only
- 91111 covers capsule imaging of the esophagus, while 91113 covers the colon.
- 45378ColonoscopyDiagnostic, no tissue removal
- 45378 is diagnostic colonoscopy using an endoscope for direct examination. 91113 is capsule-based colon imaging with interpretation and report.
91113 billing questions
How is 91113 distinguished from 91110?
91113 reports capsule imaging of the colon. 91110 is for capsule imaging of the small intestine, so select the code for the segment examined.
Does 91113 include the image interpretation?
The global service includes the technical service and professional interpretation with report. When those services are billed separately, modifier 26 identifies the professional component and modifier TC identifies the technical component.
What documentation supports 91113?
Document that colon capsule imaging was performed, that images were acquired, and that the physician reviewed the images and prepared an interpretation and report.
How does 91113 differ from conventional colonoscopy?
91113 describes capsule-based image acquisition and interpretation. A diagnostic colonoscopy such as 45378 uses an endoscope to directly examine the colon.
Is 91113 reported for esophageal capsule imaging?
No. 91113 is for the colon segment; 91111 describes capsule imaging of the esophagus.
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
Fee sheets
Put 91113 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet