Summary & Overview
CPT 91110: Capsule Endoscopy, Esophagus Through Ileum
CPT code 91110 represents capsule endoscopy imaging of the gastrointestinal tract from the esophagus through the ileum, interpreted and reported by a clinician. This diagnostic procedure is important nationally as a minimally invasive modality for evaluating small-bowel and upper-gastrointestinal pathology when conventional endoscopy or imaging is inconclusive or incomplete. Usage of capsule endoscopy has clinical implications for diagnosing obscure gastrointestinal bleeding, Crohn disease involvement of the small bowel, and other mucosal disorders.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common sites of service, and typical billing considerations tied to CPT code 91110. The publication summarizes national benchmarks where available, highlights recent policy or coverage trends affecting capsule endoscopy reimbursement and authorization, and outlines coding nuances relevant to documentation and reporting. Data limitations are noted when specific payer policy details are not available. The content is intended to inform clinicians, billing professionals, and policy analysts about the role and billing profile of CPT code 91110 in contemporary practice.
Billing Code Overview
CPT code 91110 describes a capsule endoscopy of the gastrointestinal tract from esophagus to ileum, including interpretation and report by the provider. The service involves ingestion and passage of a capsule containing a camera that captures images throughout the esophagus, stomach, small intestine, and ileum, with subsequent review and documentation by the interpreting clinician.
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Service type: Diagnostic gastrointestinal imaging using capsule endoscopy
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Typical site of service: Ambulatory settings such as outpatient clinics, endoscopy centers, or hospital outpatient departments
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient with intermittent iron-deficiency anemia and obscure gastrointestinal bleeding is referred for a capsule endoscopy to evaluate the small bowel. The patient has had prior upper endoscopy and colonoscopy with no identified source of bleeding. The provider orders a capsule endoscopy to image the esophagus, stomach, small intestine, and terminal ileum. On the day of service the patient swallows the ingestible video capsule in an outpatient endoscopy suite or ambulatory surgical center; ambulatory clinic or outpatient hospital are also typical sites of service. The capsule records continuous mucosal images over several hours while the patient ambulates. The provider later reviews the complete video, interprets findings such as angioectasia, ulcers, or small-bowel tumors, documents the interpretation, and prepares a written report that includes indications, findings, images/clips, and recommendations for further management. Typical workflow steps include pre-procedure consent and bowel preparation, capsule ingestion and monitoring, data download and review, interpretation and report generation, and communication of results to the referring clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When the physician performs the interpretation and report for the capsule study separate from technical equipment ownership or data capture |