Billing and Coding: Endoscopy by Capsule

Medicare Part B covers capsule endoscopy (CPT 91110/91111) with specified payment rules for global, technical, and professional components depending on place of service; telemetric capsule imaging has distinct technical and professional components and patency testing should be reported with CPT 91299. Claims must include valid ICD-10 diagnosis codes (specific IBS and abdominal pain codes are allowed when the exam is normal but symptoms persist), required documentation (assessment, history, test results, signed notes), and correct reporting of referring provider NPI; separate E&M for capsule ingestion is not payable and appropriate ABN modifiers (-GA, -GX, -GZ, -GY) must be used per described rules.

"Capsule endoscopy (CPT 91110, 91111 global) is payable under Medicare Part B when performed in office (POS 11), independent diagnostic testing facility (POS 49), or independent clinic (POS 49)."