CPT 91111
Global XXX ActiveGi trc img intral esophagus
CPT 91111 Billing & Documentation Guide
CPT code 91111 (Gi trc img intral esophagus) is classified under Gastro Diagnostics with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.88, a non-facility practice expense RVU of 27.72, and a malpractice RVU of 0.05, a total non-facility RVU of 28.65 and facility RVU of 28.65. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $997.69, though rates vary from $825.58 to $1368.63 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 91111, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 91111 with related codes; this code has 9 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 91111 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 91111
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.88 | 0.88 |
| Practice Expense RVU | 27.72 | 27.72 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 28.65 | 28.65 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 91111
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1126.91 | $1126.91 | $1045.54 - $1368.63 | 29 |
| Florida | $961.6 | $961.6 | $917.04 - $997.45 | 3 |
| Georgia | $914.71 | $914.71 | $857.26 - $972.17 | 2 |
| Illinois | $927.31 | $927.31 | $877.33 - $983.43 | 4 |
| Michigan | $901.14 | $901.14 | $876.6 - $925.68 | 2 |
| North Carolina | $894.3 | $894.3 | $894.3 - $894.3 | 1 |
| New York | $1065.96 | $1065.96 | $910.15 - $1135.24 | 5 |
| Ohio | $876.4 | $876.4 | $876.4 - $876.4 | 1 |
| Pennsylvania | $938.34 | $938.34 | $880.92 - $995.75 | 2 |
| Texas | $942.63 | $942.63 | $873.49 - $1010.5 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 91111
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 91111 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0242T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0355T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 91113 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0651T | Column 2 (secondary), bundled into primary | No | CPT Manual or CMS manual coding instruction |
| 91110 | Column 2 (secondary), bundled into primary | No | CPT Manual or CMS manual coding instruction |
| 91112 | Column 2 (secondary), bundled into primary | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 91111
What does CPT code 91111 mean? +
CPT code 91111 represents: Gi trc img intral esophagus. It's in the Gastro Diagnostics category with a global period of XXX.
What is the Medicare reimbursement for CPT 91111? +
The 2026 Medicare national average non-facility payment for CPT 91111 is $997.69. Rates range from $825.58 to $1368.63 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 91111? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 91111? +
This code has 9 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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