Find policies, billing codes, payers, states, and providers

HCPCS A9268: Programmer for Transient Orally Ingested Capsule

HCPCS Level II code A9268 designates the programmer used for a transient, orally ingested capsule — an external device that configures or activates a capsule swallowed by a patient for short-term diagnostic or therapeutic purposes. This code is important for accurate billing of device-related services that support ingestible capsule technologies, which are increasingly used in minimally invasive diagnostics and targeted therapies.

Major payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national-level overview of coding context, payer coverage considerations, and operational benchmarks where available. The publication outlines common service settings, typical clinical workflows tied to the programmer device, and implications for claims submission and documentation.

The content provides practical reference material: code description and use cases, typical sites of service, common modifiers and billing considerations, and where data is not present it is clearly noted. This resource is intended for billing professionals, clinical administrators, and policy analysts who need a concise, nationally focused briefing on HCPCS Level II code A9268 and its role in billing for transient, orally ingested capsule procedures and services.

Customize your policy alerts

Sign up for hcpcs A9268 policy alerts

Get alerted when payer policies referencing A9268 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

HCPCS Level II code A9268 describes a programmer for a transient, orally ingested capsule. This code represents the external programming device used to configure or activate a capsule that is swallowed by a patient for a transient diagnostic or therapeutic function.

Service Type: Device programming / Device management for ingestible capsule

Typical Site of Service: Outpatient hospital, ambulatory surgical center, clinic, or physician office where the capsule is administered and programmed

Find policies, billing codes, payers, states, and providers

HCPCS A9268: Programmer for Transient Orally Ingested Capsule

Customize your policy alerts

Sign up for hcpcs A9268 policy alerts

Get alerted when payer policies referencing A9268 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service Type: Device programming / Device management for ingestible capsule

Typical Site of Service: Outpatient hospital, ambulatory surgical center, clinic, or physician office where the capsule is administered and programmed

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult referred to an outpatient gastroenterology clinic for evaluation of suspected small-bowel bleeding, obscure gastrointestinal symptoms, or investigation of small-bowel pathology. The clinical workflow begins with history and physical examination, review of prior imaging and endoscopic studies, and ordering of a transient, orally ingested capsule procedure (wireless capsule endoscopy). The programmer device A9268 is used by trained clinical staff or a technician to configure and program the capsule recorder and to set study parameters (recording start/stop times, sensor sensitivity, patient identifiers) before the patient swallows the capsule. The patient swallows the capsule in the clinic; the programmer confirms activation and records baseline status. The patient ambulates per protocol for 8–12 hours while wearing the external data recorder; the programmer is used again after study completion to download or synchronize data to the workstation for image review by the interpreting physician. Typical sites of service include outpatient hospital endoscopy units, ambulatory surgery centers, and gastroenterology clinics. Common clinical indications include obscure gastrointestinal bleeding, iron deficiency anemia of unknown source, suspected Crohn disease of the small bowel, and surveillance of small-bowel lesions.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work or resources for programming and study setup substantially exceed typical requirements.
`23`	Unusual anesthesia	Not typically applicable to capsule programming; use only if general anesthesia unrelated to the procedure was required and documented.
`52`	Reduced services	Use when the programming service was partially performed or shortened (for example aborted study before full activation).
`53`	Discontinued procedure	Use when programming was initiated but the procedure was terminated prior to capsule ingestion for documented reasons.
`54`	Surgical care only	Rarely used; apply only when programming is billed separately and professional surgical care is billed by another provider.
`55`	Postoperative management only	Rarely applicable; use if this service is solely postoperative management distinct from programming.
`56`	Preoperative management only	Use if programming activity is limited to pre-procedure management billed separately.
`62`	Two surgeons	Use only if two surgeons or proceduralists are involved in a billable manner for programming-related operative support.
`AS`	Independent health facility service	Use when the service is furnished in an ambulatory surgical center and modifier AS is required by payors.
`QX`	Services performed by CRNA with medical direction	Use when a certified registered nurse anesthetist performs billable services under medical direction relevant to the encounter.

Taxonomy Code	Specialty	Notes
`207RC0000X`	Gastroenterology	Gastroenterologists interpret capsule endoscopy images and order programming services.
`207L00000X`	Internal Medicine	Hospitalists or internists may coordinate and perform programming in some settings.
`363A00000X`	Radiology (Diagnostic)	Diagnostic radiologists may be involved in interpretation when indicated.
`367500000X`	Nurse Practitioner	Advanced practice providers often perform programming and patient instruction for capsule studies.
`208000000X`	General Surgery	Surgeons may be involved in complex cases or when combined with operative procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K92.1`	Melena	Indicative of upper or small-bowel bleeding prompting capsule endoscopy.
`D50.9`	Iron deficiency anemia, unspecified	Unexplained iron deficiency often leads to capsule endoscopy to evaluate occult small-bowel blood loss.
`K52.9`	Noninfective gastroenteritis and colitis, unspecified	Small-bowel inflammatory processes may be evaluated with capsule endoscopy.
`K50.90`	Crohn disease, unspecified, without complications	Suspected or known Crohn disease involving the small intestine is a common indication.
`R10.9`	Abdominal pain, unspecified	Persistent abdominal pain without clear source may prompt capsule evaluation of the small bowel.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`91110`	Capsule endoscopy, esophagus, with interpretation and report	Performed when the capsule study targets the esophagus; programming `A9268` configures the capsule recorder prior to ingestion.
`91112`	Capsule endoscopy, small intestine, with interpretation and report	Commonly paired; `A9268` programs the capsule recorder and study parameters before `91112` capture and interpretation.
`91113`	Capsule endoscopy, small bowel, with remote data storage and computer-assisted analysis	Programming supports the capture and synchronization required for advanced data storage and analysis workflows.
`99213`	Office or other outpatient visit for evaluation and management, established patient, low to moderate complexity	Used for the outpatient visit where the capsule study is ordered and programming is explained; occurs before `A9268` programming.
`99070`	Supplies and materials (eg, equipment) used directly by the provider, unlisted	May be used for accessory supplies related to the programmer or external recorder when not separately reimbursed.

Related Codes

HCPCS-A9150-NON-PRESCRIPTION-DRUGS

HCPCS Level II A9150: Non-Prescription Drugs

HCPCS-A9152-SINGLE-ORAL-VITAMIN-MINERAL-DOSE

HCPCS A9152: Single Oral Vitamin/Mineral/Trace Element, Per Dose

HCPCS-A9153-MULTIVITAMIN-ORAL-PER-DOSE

HCPCS A9153: Multiple Vitamins, Oral, Per Dose

HCPCS-A9154-ARTIFICIAL-SALIVA-1ML

HCPCS Level II A9154: Artificial Saliva, 1 ml

HCPCS-A9155-ARTIFICIAL-SALIVA-30ML

HCPCS A9155: Artificial Saliva, 30 ml

HCPCS-A9156-ORAL-MUCOADHESIVE-PER-1ML

HCPCS A9156: Oral Mucoadhesive, Per 1 ml

HCPCS-A9180-PEDICULOSIS-TOPICAL-TREATMENT-PATIENT-ADMINISTRATION

HCPCS Level II A9180: Pediculosis Topical Treatment for Patient/Caretaker

HCPCS-A9269-PROGRAMMABLE-TRANSIENT-ORAL-CAPSULE

HCPCS A9269: Programmable Transient Orally Ingested Capsule, Monthly

HCPCS-A9270-NON-COVERED-ITEM-OR-SERVICE

HCPCS Level II A9270: Non-covered Item or Service

HCPCS-A9272-DISPOSABLE-WOUND-SUCTION-DEVICE-KIT

HCPCS A9272: Disposable Wound Suction Device Kit, Per Item

Showing 1–10 of 138

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

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

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.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documented work or resources for programming and study setup substantially exceed typical requirements.
`23`	Unusual anesthesia	Not typically applicable to capsule programming; use only if general anesthesia unrelated to the procedure was required and documented.
`52`	Reduced services	Use when the programming service was partially performed or shortened (for example aborted study before full activation).
`53`	Discontinued procedure	Use when programming was initiated but the procedure was terminated prior to capsule ingestion for documented reasons.
`54`	Surgical care only	Rarely used; apply only when programming is billed separately and professional surgical care is billed by another provider.
`55`	Postoperative management only	Rarely applicable; use if this service is solely postoperative management distinct from programming.
`56`	Preoperative management only	Use if programming activity is limited to pre-procedure management billed separately.
`62`	Two surgeons	Use only if two surgeons or proceduralists are involved in a billable manner for programming-related operative support.
`AS`	Independent health facility service	Use when the service is furnished in an ambulatory surgical center and modifier AS is required by payors.
`QX`	Services performed by CRNA with medical direction	Use when a certified registered nurse anesthetist performs billable services under medical direction relevant to the encounter.

Taxonomy Code	Specialty	Notes
`207RC0000X`	Gastroenterology	Gastroenterologists interpret capsule endoscopy images and order programming services.
`207L00000X`	Internal Medicine	Hospitalists or internists may coordinate and perform programming in some settings.
`363A00000X`	Radiology (Diagnostic)	Diagnostic radiologists may be involved in interpretation when indicated.
`367500000X`	Nurse Practitioner	Advanced practice providers often perform programming and patient instruction for capsule studies.
`208000000X`	General Surgery	Surgeons may be involved in complex cases or when combined with operative procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K92.1`	Melena	Indicative of upper or small-bowel bleeding prompting capsule endoscopy.
`D50.9`	Iron deficiency anemia, unspecified	Unexplained iron deficiency often leads to capsule endoscopy to evaluate occult small-bowel blood loss.
`K52.9`	Noninfective gastroenteritis and colitis, unspecified	Small-bowel inflammatory processes may be evaluated with capsule endoscopy.
`K50.90`	Crohn disease, unspecified, without complications	Suspected or known Crohn disease involving the small intestine is a common indication.
`R10.9`	Abdominal pain, unspecified	Persistent abdominal pain without clear source may prompt capsule evaluation of the small bowel.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`91110`	Capsule endoscopy, esophagus, with interpretation and report	Performed when the capsule study targets the esophagus; programming `A9268` configures the capsule recorder prior to ingestion.
`91112`	Capsule endoscopy, small intestine, with interpretation and report	Commonly paired; `A9268` programs the capsule recorder and study parameters before `91112` capture and interpretation.
`91113`	Capsule endoscopy, small bowel, with remote data storage and computer-assisted analysis	Programming supports the capture and synchronization required for advanced data storage and analysis workflows.
`99213`	Office or other outpatient visit for evaluation and management, established patient, low to moderate complexity	Used for the outpatient visit where the capsule study is ordered and programming is explained; occurs before `A9268` programming.
`99070`	Supplies and materials (eg, equipment) used directly by the provider, unlisted	May be used for accessory supplies related to the programmer or external recorder when not separately reimbursed.

Related Codes

HCPCS-A9150-NON-PRESCRIPTION-DRUGS

HCPCS Level II A9150: Non-Prescription Drugs

HCPCS-A9152-SINGLE-ORAL-VITAMIN-MINERAL-DOSE

HCPCS A9152: Single Oral Vitamin/Mineral/Trace Element, Per Dose

HCPCS-A9153-MULTIVITAMIN-ORAL-PER-DOSE

HCPCS A9153: Multiple Vitamins, Oral, Per Dose

HCPCS-A9154-ARTIFICIAL-SALIVA-1ML

HCPCS Level II A9154: Artificial Saliva, 1 ml

HCPCS-A9155-ARTIFICIAL-SALIVA-30ML

HCPCS A9155: Artificial Saliva, 30 ml

HCPCS-A9156-ORAL-MUCOADHESIVE-PER-1ML

HCPCS A9156: Oral Mucoadhesive, Per 1 ml

HCPCS-A9180-PEDICULOSIS-TOPICAL-TREATMENT-PATIENT-ADMINISTRATION

HCPCS Level II A9180: Pediculosis Topical Treatment for Patient/Caretaker

HCPCS-A9269-PROGRAMMABLE-TRANSIENT-ORAL-CAPSULE

HCPCS A9269: Programmable Transient Orally Ingested Capsule, Monthly

HCPCS-A9270-NON-COVERED-ITEM-OR-SERVICE

HCPCS Level II A9270: Non-covered Item or Service

HCPCS-A9272-DISPOSABLE-WOUND-SUCTION-DEVICE-KIT

HCPCS A9272: Disposable Wound Suction Device Kit, Per Item

Showing 1–10 of 138

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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

HCPCS A9268: Programmer for Transient Orally Ingested Capsule

Sign up for hcpcs A9268 policy alerts

Billing Code Overview

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

HCPCS A9268: Programmer for Transient Orally Ingested Capsule

Sign up for hcpcs A9268 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

HCPCS A9268: Programmer for Transient Orally Ingested Capsule

Sign up for hcpcs A9268 policy alerts

Billing Code Overview

HCPCS A9268: Programmer for Transient Orally Ingested Capsule

Sign up for hcpcs A9268 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code A9268 describe and where is it typically used?

How does A9268 relate to other CPT codes for capsule endoscopy?

Which modifiers are commonly noted for use with A9268 and when would they apply?

Which specialties and provider types commonly perform or support services billed with A9268?

Does the document provide reimbursement rates or payer-specific coverage rules for A9268?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code A9268 describe and where is it typically used?

How does A9268 relate to other CPT codes for capsule endoscopy?

Which modifiers are commonly noted for use with A9268 and when would they apply?

Which specialties and provider types commonly perform or support services billed with A9268?

Does the document provide reimbursement rates or payer-specific coverage rules for A9268?

References