Billing code 91111: Capsule imagingMedicare rate & RVUs
Reports capsule-based imaging limited to the esophagus, including the technical study and interpretation when performed as a complete service.
Medicare pays $956.94 for 91111 nationally in the office. Local office rates run $825.58–$1,368.63.
Medicare rate · 91111
Capsule imaging
Swap in your local Medicare rate.
- Work RVUs
- 0.88
- Total RVUs
- 28.65
- Global days
- XXX
National rate · 2026
$956.94
Office setting, before claim adjustments.
See every locality for 91111 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 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
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$825.58 to $1368.63
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $840.48 | Unavailable |
| Alaska* | $1,031.06 | Unavailable |
| Arizona | $927.99 | Unavailable |
| Arkansas | $825.58 | Unavailable |
| Atlanta | $972.17 | Unavailable |
| Austin | $1,010.50 | Unavailable |
| Bakersfield | $1,045.73 | Unavailable |
| Baltimore/Surr. Cntys | $1,025.39 | Unavailable |
| Beaumont | $873.49 | Unavailable |
| Brazoria | $948.47 | Unavailable |
| Chicago | $963.93 | Unavailable |
| Chico | $1,045.54 | Unavailable |
| Colorado | $1,016.18 | Unavailable |
| Connecticut | $1,029.17 | Unavailable |
| Dallas | $953.26 | Unavailable |
| Dc + Md/Va Suburbs | $1,123.52 | Unavailable |
| Delaware | $945.80 | Unavailable |
| Detroit | $925.68 | Unavailable |
| East St. Louis | $884.56 | Unavailable |
| El Centro | $1,045.55 | Unavailable |
| Fort Lauderdale | $970.32 | Unavailable |
| Fort Worth | $944.02 | Unavailable |
| Fresno | $1,045.54 | Unavailable |
| Galveston | $950.40 | Unavailable |
| Hanford-Corcoran | $1,045.54 | Unavailable |
| Hawaii, Guam | $1,083.08 | Unavailable |
| Houston | $951.32 | Unavailable |
| Idaho | $881.99 | Unavailable |
| Indiana | $888.49 | Unavailable |
| Iowa | $877.23 | Unavailable |
| Kansas | $867.22 | Unavailable |
| Kentucky | $854.02 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $1,127.01 | Unavailable |
| Madera | $1,045.54 | Unavailable |
| Manhattan | $1,109.79 | Unavailable |
| Merced | $1,045.54 | Unavailable |
| Metropolitan Boston | $1,137.58 | Unavailable |
| Metropolitan Kansas City | $900.42 | Unavailable |
| Metropolitan Philadelphia | $995.75 | Unavailable |
| Metropolitan St. Louis | $912.50 | Unavailable |
| Miami | $997.45 | Unavailable |
| Minnesota | $982.61 | Unavailable |
| Mississippi | $827.80 | Unavailable |
| Modesto | $1,045.54 | Unavailable |
| Montana** | $956.93 | Unavailable |
| Napa | $1,252.39 | Unavailable |
| Nebraska | $884.60 | Unavailable |
| Nevada** | $957.58 | Unavailable |
| New Hampshire | $994.69 | Unavailable |
| New Mexico | $880.42 | Unavailable |
| New Orleans | $902.54 | Unavailable |
| North Carolina | $894.30 | Unavailable |
| North Dakota** | $955.94 | Unavailable |
| Northern Nj | $1,107.04 | Unavailable |
| Nyc Suburbs/Long Island | $1,135.24 | Unavailable |
| Ohio | $876.40 | Unavailable |
| Oklahoma | $857.49 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $1,125.64 | Unavailable |
| Portland | $1,059.75 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $1,046.57 | Unavailable |
| Puerto Rico | $967.10 | Unavailable |
| Queens | $1,128.06 | Unavailable |
| Redding | $1,045.54 | Unavailable |
| Rest Of California | $1,045.54 | Unavailable |
| Rest Of Florida | $917.04 | Unavailable |
| Rest Of Georgia | $857.26 | Unavailable |
| Rest Of Illinois | $877.33 | Unavailable |
| Rest Of Louisiana | $850.39 | Unavailable |
| Rest Of Maine | $882.23 | Unavailable |
| Rest Of Maryland | $968.20 | Unavailable |
| Rest Of Massachusetts | $1,006.14 | Unavailable |
| Rest Of Michigan | $876.60 | Unavailable |
| Rest Of Missouri | $829.12 | Unavailable |
| Rest Of New Jersey | $1,043.45 | Unavailable |
| Rest Of New York | $910.15 | Unavailable |
| Rest Of Oregon | $952.74 | Unavailable |
| Rest Of Pennsylvania | $880.92 | Unavailable |
| Rest Of Texas | $909.55 | Unavailable |
| Rest Of Washington | $1,005.99 | Unavailable |
| Rhode Island | $987.87 | Unavailable |
| Riverside-San Bernardino-Ontario | $1,046.10 | Unavailable |
| Sacramento-Roseville-Folsom | $1,108.14 | Unavailable |
| Salinas | $1,104.29 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $1,138.52 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $1,338.43 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $1,338.38 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $1,368.63 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $1,368.40 | Unavailable |
| San Luis Obispo-Paso Robles | $1,085.36 | Unavailable |
| Santa Cruz-Watsonville | $1,155.84 | Unavailable |
| Santa Maria-Santa Barbara | $1,110.68 | Unavailable |
| Santa Rosa-Petaluma | $1,168.14 | Unavailable |
| Seattle (King Cnty) | $1,168.27 | Unavailable |
| South Carolina | $886.32 | Unavailable |
| South Dakota** | $955.83 | Unavailable |
| Southern Maine | $947.99 | Unavailable |
| Stockton | $1,045.54 | Unavailable |
| Suburban Chicago | $983.43 | Unavailable |
| Tennessee | $871.91 | Unavailable |
| Utah | $901.21 | Unavailable |
| Vallejo | $1,252.31 | Unavailable |
| Vermont | $946.85 | Unavailable |
| Virgin Islands | $967.10 | Unavailable |
| Virginia | $940.70 | Unavailable |
| Visalia | $1,045.54 | Unavailable |
| West Virginia | $836.37 | Unavailable |
| Wisconsin | $916.89 | Unavailable |
| Wyoming** | $956.50 | Unavailable |
| Yuba City | $1,045.54 | Unavailable |
91111 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$825.58
$1,207.09
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,031.06 | 1 |
| AL | $840.48 | 1 |
| AR | $825.58 | 1 |
| AZ | $927.99 | 1 |
| CA | $1,045.54–$1,368.63 | 29 |
| CO | $1,016.18 | 1 |
| CT | $1,029.17 | 1 |
| DC | $1,123.52 | 1 |
| DE | $945.80 | 1 |
| FL | $917.04–$997.45 | 3 |
| GA | $857.26–$972.17 | 2 |
| GU | $1,083.08 | 1 |
| HI | $1,083.08 | 1 |
| IA | $877.23 | 1 |
| ID | $881.99 | 1 |
| IL | $877.33–$983.43 | 4 |
| IN | $888.49 | 1 |
| KS | $867.22 | 1 |
| KY | $854.02 | 1 |
| LA | $850.39–$902.54 | 2 |
| MA | $1,006.14–$1,137.58 | 2 |
| MD | $968.20–$1,123.52 | 3 |
| ME | $882.23–$947.99 | 2 |
| MI | $876.60–$925.68 | 2 |
| MN | $982.61 | 1 |
| MO | $829.12–$912.50 | 3 |
| MS | $827.80 | 1 |
| MT | $956.93 | 1 |
| NC | $894.30 | 1 |
| ND | $955.94 | 1 |
| NE | $884.60 | 1 |
| NH | $994.69 | 1 |
| NJ | $1,043.45–$1,107.04 | 2 |
| NM | $880.42 | 1 |
| NV | $957.58 | 1 |
| NY | $910.15–$1,135.24 | 5 |
| OH | $876.40 | 1 |
| OK | $857.49 | 1 |
| OR | $952.74–$1,059.75 | 2 |
| PA | $880.92–$995.75 | 2 |
| PR | $967.10 | 1 |
| RI | $987.87 | 1 |
| SC | $886.32 | 1 |
| SD | $955.83 | 1 |
| TN | $871.91 | 1 |
| TX | $873.49–$1,010.50 | 8 |
| UT | $901.21 | 1 |
| VA | $940.70–$1,123.52 | 2 |
| VI | $967.10 | 1 |
| VT | $946.85 | 1 |
| WA | $1,005.99–$1,168.27 | 2 |
| WI | $916.89 | 1 |
| WV | $836.37 | 1 |
| WY | $956.50 | 1 |
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
Swap in your local Medicare rate.
Work 0.88Practice expense 27.72Malpractice 0.05
All indexes start 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
| 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
91111-26 · Professional component
$47.76
Pays only the interpretation and report.
91111 compared with similar codes
Compare codes
91111 vs 91110 vs 91113 vs 91112 vs 43200: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 91110Capsule imaging
- 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 imaging
- 91113 reports capsule imaging of the colon; 91111 reports imaging limited to the esophagus.
- 91112Motility capsule
- 91112 measures gastrointestinal transit and pressure using a wireless capsule. It is a physiologic study, not capsule imaging of esophageal mucosa.
- 43200Esophagoscopy
- 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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