CPT 91111: Esophageal Capsule Endoscopy, Imaging and Interpretation

CPT code 91111 represents capsule endoscopy targeted to esophageal imaging, including image interpretation and report generation. Nationally, this code captures a minimally invasive diagnostic alternative to traditional endoscopy for select esophageal indications and informs utilization, coverage, and payment policy discussions for advanced endoscopic imaging technologies. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise overview of clinical context for esophageal capsule endoscopy, payer coverage patterns, and practical benchmarks relevant to billing and documentation. The publication outlines common modifiers and coding considerations, typical sites of service where CPT code 91111 is billed, and what to expect in claims handling and reporting. Also included are notes on coding alignment with related services and national policy trends affecting adoption of capsule endoscopy. This resource is intended to support coding accuracy, payer discussions, and operational planning for practices and health systems that offer capsule-based esophageal imaging.

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Billing Code Overview

CPT code 91111 describes capsule endoscopy of the esophagus, in which a provider performs gastrointestinal tract imaging specifically for evaluation of the esophagus, interprets the captured images, and prepares a report. This service involves use of an ingestible capsule equipped with a camera that transmits images while traversing the esophagus.

Service type: Diagnostic imaging and interpretation
Typical site of service: Ambulatory settings such as outpatient endoscopy centers or hospital outpatient departments; may also be performed in clinic settings equipped for capsule endoscopy

Data not available in the input.

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CPT 91111: Esophageal Capsule Endoscopy, Imaging and Interpretation

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Billing Code Overview

Service type: Diagnostic imaging and interpretation
Typical site of service: Ambulatory settings such as outpatient endoscopy centers or hospital outpatient departments; may also be performed in clinic settings equipped for capsule endoscopy

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with progressive dysphagia and intermittent retrosternal discomfort is referred for esophageal visualization after inconclusive upper endoscopy due to patient intolerance. The provider administers a capsule endoscopy designed for esophageal imaging, instructs the patient on swallowing the capsule, monitors transit during the study period, downloads the recorded images, performs a diagnostic review of the entire esophageal data set, documents findings (e.g., esophagitis, erosions, ring, stricture, or retained capsule), and generates a formal interpretive report with recommendations for further management. Typical workflow includes pre-procedure verification and consent in an outpatient clinic or ambulatory surgery center, ingestion and brief observation in the clinic, technical data capture by the device vendor or facility (technical component), physician image interpretation (professional component), and final report delivery to the referring clinician. Typical site of service is an outpatient clinic, ambulatory surgery center, or hospital outpatient department. Typical patient scenario includes symptoms such as odynophagia, unexplained chest pain, suspected Barrett esophagus screening when endoscopy is contraindicated, or evaluation of intermittent dysphagia where esophageal capsule endoscopy is appropriate.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R13.10`	Dysphagia, unspecified	Common indication for esophageal imaging to evaluate structural or motility causes.
`R07.89`	Other chest pain	Unexplained chest pain where esophageal causes are considered and noninvasive visualization is useful.
`K21.9`	Gastro-esophageal reflux disease without esophagitis	Reflux symptoms prompting evaluation for mucosal injury or Barrett esophagus when endoscopy not feasible.
`K22.7`	Barrett esophagus	Surveillance or assessment when endoscopy is contraindicated or incomplete; capsule may provide imaging data.
`K20.9`	Esophagitis, unspecified	Suspected inflammatory mucosal disease; capsule can document erosions or inflammation.
`R13.11`	Dysphagia, oral phase	Specific dysphagia localization that may prompt targeted esophageal imaging.
`K22.8`	Other specified diseases of esophagus	Includes strictures, rings, or webs that capsule imaging may detect.
`K22.2`	Esophageal obstruction	Evaluation for causes of intermittent obstruction or suspected strictures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, flexible, transoral	Often performed before or after capsule endoscopy when direct visualization or tissue biopsy is required or when capsule results indicate mucosal lesions requiring endoscopic assessment.
`43239`	Upper gastrointestinal endoscopy with biopsy, single or multiple	Performed if capsule images suggest mucosal abnormality needing histologic diagnosis.
`91112`	Capsule endoscopy for gastrointestinal tract imaging, beyond esophagus; interpretive report (example related code)	Related capsule endoscopy codes for other GI segments; used when additional capsule studies are performed for small bowel evaluation following esophageal capsule findings.
`99174`	Data not available in the input.	Data not available in the input.
`99070`	Supplies and materials (used for routine and expected supplies during procedures)	Billed by facility or supplier when specific disposable supplies or device-related materials exceed typical included items.
`99457`	Data not available in the input.	Data not available in the input.

Related Modifiers

9 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
102L00000X	Psychoanalyst	Psychoanalysis is a comprehensive, theoretical framework which, when applied to a treatment process, consists of an intensive verbal, therapeutic rela…
163WC0400X	Case Management Registered Nurse	Nursing Service Providers · Registered Nurse
364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
207NS0135X	Procedural Dermatology Physician	Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue …

CPT 91110: Capsule Endoscopy, Esophagus Through Ileum

CPT-91112-WIRELESS-CAPSULE-GASTRIC-COLONIC-MOTILITY-STUDY

CPT 91112: Wireless Capsule Gastric and Colonic Motility Study

CPT-91113-COLON-CAPSULE-ENDOSCOPY-IMAGING-INTERPRETATION

CPT 91113: Colon Capsule Endoscopy Imaging and Interpretation

CPT-91117-COLONIC-MOTILITY-STUDY-MANOMETRY

CPT 91117: Colonic Motility Study (Colon Manometry)

CPT-91124-RECTAL-SENSATION-TONE-COMPLIANCE-STUDY

CPT 91124: Rectal Sensation, Tone, and Compliance Study

CPT-91125-ANORECTAL-MANOMETRY-AND-RECTAL-FUNCTION-TESTING

CPT 91125: Anorectal Manometry and Rectal Function Testing

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R13.10`	Dysphagia, unspecified	Common indication for esophageal imaging to evaluate structural or motility causes.
`R07.89`	Other chest pain	Unexplained chest pain where esophageal causes are considered and noninvasive visualization is useful.
`K21.9`	Gastro-esophageal reflux disease without esophagitis	Reflux symptoms prompting evaluation for mucosal injury or Barrett esophagus when endoscopy not feasible.
`K22.7`	Barrett esophagus	Surveillance or assessment when endoscopy is contraindicated or incomplete; capsule may provide imaging data.
`K20.9`	Esophagitis, unspecified	Suspected inflammatory mucosal disease; capsule can document erosions or inflammation.
`R13.11`	Dysphagia, oral phase	Specific dysphagia localization that may prompt targeted esophageal imaging.
`K22.8`	Other specified diseases of esophagus	Includes strictures, rings, or webs that capsule imaging may detect.
`K22.2`	Esophageal obstruction	Evaluation for causes of intermittent obstruction or suspected strictures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, flexible, transoral	Often performed before or after capsule endoscopy when direct visualization or tissue biopsy is required or when capsule results indicate mucosal lesions requiring endoscopic assessment.
`43239`	Upper gastrointestinal endoscopy with biopsy, single or multiple	Performed if capsule images suggest mucosal abnormality needing histologic diagnosis.
`91112`	Capsule endoscopy for gastrointestinal tract imaging, beyond esophagus; interpretive report (example related code)	Related capsule endoscopy codes for other GI segments; used when additional capsule studies are performed for small bowel evaluation following esophageal capsule findings.
`99174`	Data not available in the input.	Data not available in the input.
`99070`	Supplies and materials (used for routine and expected supplies during procedures)	Billed by facility or supplier when specific disposable supplies or device-related materials exceed typical included items.
`99457`	Data not available in the input.	Data not available in the input.

Related Modifiers

9 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
102L00000X	Psychoanalyst	Psychoanalysis is a comprehensive, theoretical framework which, when applied to a treatment process, consists of an intensive verbal, therapeutic rela…
163WC0400X	Case Management Registered Nurse	Nursing Service Providers · Registered Nurse
364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
207NS0135X	Procedural Dermatology Physician	Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue …

CPT 91110: Capsule Endoscopy, Esophagus Through Ileum

CPT-91112-WIRELESS-CAPSULE-GASTRIC-COLONIC-MOTILITY-STUDY

CPT 91112: Wireless Capsule Gastric and Colonic Motility Study

CPT-91113-COLON-CAPSULE-ENDOSCOPY-IMAGING-INTERPRETATION

CPT 91113: Colon Capsule Endoscopy Imaging and Interpretation

CPT-91117-COLONIC-MOTILITY-STUDY-MANOMETRY

CPT 91117: Colonic Motility Study (Colon Manometry)

CPT-91124-RECTAL-SENSATION-TONE-COMPLIANCE-STUDY

CPT 91124: Rectal Sensation, Tone, and Compliance Study

CPT-91125-ANORECTAL-MANOMETRY-AND-RECTAL-FUNCTION-TESTING

CPT 91125: Anorectal Manometry and Rectal Function Testing

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 91111: Esophageal Capsule Endoscopy, Imaging and Interpretation

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Billing Code Overview

OpenPayer

CPT 91111: Esophageal Capsule Endoscopy, Imaging and Interpretation

Sign up for cpt 91111 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

CPT 91111: Esophageal Capsule Endoscopy, Imaging and Interpretation

Sign up for cpt 91111 policy alerts

Billing Code Overview

CPT 91111: Esophageal Capsule Endoscopy, Imaging and Interpretation

Sign up for cpt 91111 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 91111 cover and where is this service typically performed?

When should I use modifiers 26 and TC with CPT 91111?

How does CPT 91111 relate to other endoscopy or capsule codes?

What diagnoses are commonly reported with CPT 91111?

What documentation and coding considerations should I be aware of when billing CPT 91111?

References

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 91111 cover and where is this service typically performed?

When should I use modifiers 26 and TC with CPT 91111?

How does CPT 91111 relate to other endoscopy or capsule codes?

What diagnoses are commonly reported with CPT 91111?

What documentation and coding considerations should I be aware of when billing CPT 91111?

References