CPT 91112
Global XXX ActiveGi wireless capsule measure
CPT 91112 Billing & Documentation Guide
CPT code 91112 (Gi wireless capsule measure) is classified under Gastro Diagnostics with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.05, a non-facility practice expense RVU of 50.76, and a malpractice RVU of 0.1, a total non-facility RVU of 52.91 and facility RVU of 52.91. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1842.14, though rates vary from $1526.57 to $2522.6 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 91112, 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 91112 with related codes; this code has 10 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 91112 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 91112
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.05 | 2.05 |
| Practice Expense RVU | 50.76 | 50.76 |
| Malpractice RVU | 0.1 | 0.1 |
| Total RVU | 52.91 | 52.91 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 91112
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 | $2078.9 | $2078.9 | $1929.62 - $2522.6 | 29 |
| Florida | $1776.05 | $1776.05 | $1694.32 - $1841.86 | 3 |
| Georgia | $1690.01 | $1690.01 | $1584.78 - $1795.25 | 2 |
| Illinois | $1713.3 | $1713.3 | $1621.62 - $1816.08 | 4 |
| Michigan | $1665.18 | $1665.18 | $1620.17 - $1710.19 | 2 |
| North Carolina | $1652.44 | $1652.44 | $1652.44 - $1652.44 | 1 |
| New York | $1967.68 | $1967.68 | $1681.48 - $2094.92 | 5 |
| Ohio | $1619.77 | $1619.77 | $1619.77 - $1619.77 | 1 |
| Pennsylvania | $1733.33 | $1733.33 | $1628.03 - $1838.63 | 2 |
| Texas | $1741.1 | $1741.1 | $1614.42 - $1865.33 | 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 91112
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 91112 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0355T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0651T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 91112
What does CPT code 91112 mean? +
CPT code 91112 represents: Gi wireless capsule measure. It's in the Gastro Diagnostics category with a global period of XXX.
What is the Medicare reimbursement for CPT 91112? +
The 2026 Medicare national average non-facility payment for CPT 91112 is $1842.14. Rates range from $1526.57 to $2522.6 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 91112? +
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 91112? +
This code has 10 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 June 1, 2026.
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