$946.85
91111 is limited to esophageal capsule imaging; 91110 covers an examination extending through the gastrointestinal tract to the ileum.
On this page
CMS RVU26D · Effective 2026-10-01
91110 Capsule imaging Medicare reimbursement rates in Vermont
Reports wireless capsule imaging of the gastrointestinal tract from the esophagus through the ileum to evaluate suspected mucosal disease or bleeding. Compare 91110 office and facility rates across CMS payment localities in Vermont.
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 91110 in Vermont?
Vermont 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
$793.54
1 of 1 localities have a supported rate.
Payment area: Vermont
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 diagnostics
About 91110: Capsule imaging from esophagus through ileum
Reports wireless capsule imaging of the gastrointestinal tract from the esophagus through the ileum to evaluate suspected mucosal disease or bleeding.
A patient swallows a small camera capsule that records images as it moves through the gastrointestinal tract. The study evaluates the mucosal lining, especially the small bowel, for findings such as a suspected bleeding source or Crohn disease. A gastroenterologist or other qualified physician reviews the recorded images and prepares the interpretation and report. The service is used in outpatient and facility settings when a capsule-based examination of the tract through the ileum is performed.
Select this code for the imaging examination’s documented anatomic extent, not for a wireless capsule study that measures transit or pressure. The record should support capsule administration, image acquisition, and physician interpretation and report. CMS recognizes separately priced professional and technical portions: modifier 26 identifies interpretation, modifier TC identifies equipment and staff, and billing without either modifier represents the global service.
CMS billing rules for 91110
- 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 RVU2.18 · 9%
- Practice expense (office) RVU21.75 · 91%
- Malpractice RVU0.09 · 0%
40.2K
Medicare services in 2024 · #868 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.
91110 compared with similar codes
Office rates for Vermont, from the same CMS release.
$1,748.64
91112 measures gastrointestinal transit and pressure with a wireless capsule. Choose 91110 for capsule images used to assess mucosal findings.
$974.64
91113 reports capsule imaging of the colon, whereas 91110 describes imaging through the ileum.
Compare 91110 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
Vermont →
Office / nonfacility
$793.54
Facility
Unavailable
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 91110 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
11,621
- Code
- 91110
- Physician work
- 2.18
- Practice expense
- 21.75
- Malpractice
- 0.09
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.18 | × 1.000 | 2.1800 |
| Practice expense | 21.75 | × 0.990 | 21.5325 |
| Malpractice | 0.09 | × 0.506 | 0.0455 |
| Total RVUs | 23.7580 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$793.54
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.18 | 1 |
| Practice expense | 21.75 | 0.99 |
| Malpractice | 0.09 | 0.506 |
(2.18 × 1 + 21.75 × 0.99 + 0.09 × 0.506) × $33.4009 = $793.54
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.
91110 billing questions
When should 91110 be selected instead of 91111?
Use 91110 when the capsule imaging examination extends through the gastrointestinal tract to the ileum. Code 91111 is limited to capsule imaging of the esophagus.
How does 91110 differ from 91112?
91110 records images of the gastrointestinal mucosa. 91112 is for wireless capsule measurement of gastrointestinal transit and pressure, not mucosal imaging.
What do modifiers 26 and TC identify?
Modifier 26 identifies the physician’s interpretation and report. Modifier TC identifies the technical service, including equipment and staff; without either modifier, the claim represents the global service.
What documentation supports reporting 91110?
Document the capsule imaging performed, the examination’s extent through the ileum, and the physician’s interpretation and report. The record should also support which professional, technical, or global service is being billed.
Is 91113 interchangeable with 91110?
No. 91110 covers capsule imaging through the ileum, while 91113 identifies capsule imaging of the colon.
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.
11,61891065,,Breath hydrogen/methane test,A,,0.20,1.71,,1.71,NA,0.02,1.93,1.93,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,61991065,26,Breath hydrogen/methane test,A,,0.20,0.08,,0.08,,0.01,0.29,0.29,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,62091065,TC,Breath hydrogen/methane test,A,,0.00,1.63,,1.63,NA,0.01,1.64,1.64,1,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817