Does 91110 require prior authorization?

No, 91110 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 91110?

Medicare facility rate: $29.00. Non-facility rate: $29.00. Work RVU: 2.18.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

2.18

Facility

$29.00

Non-Facility

$29.00

All documentation must be maintained in the patient’s medical record, be legible, include patient identification and dates of service, and be available to the contractor upon request.
The record must include the legible signature of the physician or non-physician practitioner responsible for the patient’s care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
The record must document attempts to identify the bleeding source and clearly explain why the patient was not a candidate for conventional endoscopy, including specific comorbidities or complicating medical conditions.

Wireless capsule endoscopy of the small bowel (including esophagus through ileum) is billed with CPT 91110 when clinically indicated.
Wireless capsule endoscopy limited to the esophagus is billed with CPT 91111 when clinically indicated.
Capsule endoscopy may be used when attempts were made to identify a gastrointestinal bleeding source but the site was not identified by prior colonoscopy or endoscopy.
Capsule endoscopy is indicated when the patient is not a candidate for conventional endoscopy and the medical record documents specific comorbidities/complicating conditions and explains why the risk/benefit ratio for conventional endoscopy is unfavorable.
The medical record must support how the capsule endoscopy would contribute to the patient’s care (expected diagnostic or management impact).
A dual diagnosis is required on the claim when billing for wireless capsule endoscopy.

L33693 — Peripheral Venous Ultrasound

J09

L33774 — Wireless Capsule Endoscopy

J09

A56704 — Billing and Coding: Wireless Capsule Endoscopy

J09

L37371 — Electroretinography (ERG)

J12

L35007 — Vestibular and Audiologic Function Studies

Ask Verity about documentation requirements, denial risks, or coverage in your state.