$758.39
Choose 91111 when the capsule study is limited to the esophagus. Choose 91110 when the study extends through the gastrointestinal tract to the ileum.
On this page
CMS RVU26D · Effective 2026-10-01
91111 Capsule imaging Medicare reimbursement rates in Utah
Reports capsule-based imaging limited to the esophagus, including the technical study and interpretation when performed as a complete service. Compare 91111 office and facility rates across CMS payment localities in Utah.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 91111 in Utah?
Utah has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$901.21
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Gastrointestinal imaging
About 91111: Esophageal capsule imaging study
Reports capsule-based imaging limited to the esophagus, including the technical study and interpretation when performed as a complete service.
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.
CMS billing rules for 91111
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
Where the value comes from
- Work RVU0.88 · 3%
- Practice expense (office) RVU27.72 · 97%
- Malpractice RVU0.05 · 0%
169
Medicare services in 2024 · #4482 by national volume
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.
91111 compared with similar codes
Office rates for Utah, from the same CMS release.
$930.78
91113 reports capsule imaging of the colon; 91111 reports imaging limited to the esophagus.
$1,665.18
91112 measures gastrointestinal transit and pressure using a wireless capsule. It is a physiologic study, not capsule imaging of esophageal mucosa.
$272.17
43200 is direct flexible esophagoscopy. It uses an endoscope for visual examination, while 91111 uses images captured by a swallowed capsule.
Compare 91111 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Utah →
Office / nonfacility
$901.21
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 91111 in Utah.
PPRRVU2026_Oct_nonQPP.csv
11,624
- Code
- 91111
- Physician work
- 0.88
- Practice expense
- 27.72
- Malpractice
- 0.05
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.88 | × 1.000 | 0.8800 |
| Practice expense | 27.72 | × 0.940 | 26.0568 |
| Malpractice | 0.05 | × 0.898 | 0.0449 |
| Total RVUs | 26.9817 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$901.21
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.88 | 1 |
| Practice expense | 27.72 | 0.94 |
| Malpractice | 0.05 | 0.898 |
(0.88 × 1 + 27.72 × 0.94 + 0.05 × 0.898) × $33.4009 = $901.21
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
11,62191110,,Gi trc img intral esoph-ile,A,,2.18,21.75,,21.75,NA,0.09,24.02,24.02,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,29.00,29.00,0.09
11,62291110,26,Gi trc img intral esoph-ile,A,,2.18,1.27,,1.27,,0.08,3.53,3.53,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,62391110,TC,Gi trc img intral esoph-ile,A,,0.00,20.48,,20.48,NA,0.01,20.49,20.49,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,27.73,27.73,0.01
11,62491111,,Gi trc img intral esophagus,A,,0.88,27.72,,27.72,NA,0.05,28.65,28.65,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,28.24,28.24,0.05
11,62591111,26,Gi trc img intral esophagus,A,,0.88,0.51,,0.51,,0.04,1.43,1.43,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,62691111,TC,Gi trc img intral esophagus,A,,0.00,27.21,,27.21,NA,0.01,27.22,27.22,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,27.73,27.73,0.01
11,62791112,,Gi wireless capsule measure,A,,2.05,50.76,,50.76,NA,0.10,52.91,52.91,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985