CPT code 91110 is for gastrointestinal tract imaging using intraluminal esophageal-ileal techniques to assess digestive health.
CPT code 91110 is for gastrointestinal tract imaging using intraluminal esophageal and ileal techniques. This procedure involves the use of imaging technology to visualize the esophagus and ileum, which are parts of the digestive system. It is typically performed to assess conditions affecting these areas, helping healthcare providers diagnose and manage gastrointestinal disorders effectively.
For CPT code 91110, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: Used when only the professional component of the service is being billed, such as the interpretation of the test results by a physician.
2. Modifier TC - Technical Component: Used when only the technical component of the service is being billed, such as the use of the equipment and the technician's time.
3. Modifier 52 - Reduced Services: Used when the service provided is less extensive than described in the CPT code.
4. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help provide additional information about the service performed and ensure accurate billing and reimbursement.
Determining if CPT code 91110 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 91110 is reimbursed, you would need to check the MPFS database, which is accessible online through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, MACs, which are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries, may have specific local coverage determinations (LCDs) that could affect reimbursement.
In summary, to determine if CPT code 91110 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC for any specific coverage guidelines or restrictions.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 91110. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
