How much does Medicare pay for CPT 91110?

Medicare allowed an average of $471.78 per service and paid $372.85 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2018.57, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 91110?

Imaging of digestive tract done from the inside of the digestive tract. It was billed 15,537 times to 14,875 Medicare beneficiaries by 769 providers in 2024.

Does 91110 pay differently in an office than a hospital?

Yes. The allowed amount averaged $668.68 in an office setting and $109.11 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 91110 most?

Gastroenterology, with 14,242 services from 702 clinicians. Next are Internal Medicine, Physician Assistant, Nurse Practitioner.

CPT 91110

Imaging of digestive tract done from the inside of the digestive tract

$471.78Medicare-allowed amount per service, averaged across 15,537 services

Providers submitted

$2018.57

Asking price, not received

Medicare allowed

$471.78

The fee schedule figure

Medicare paid

$372.85

Balance is patient coinsurance

Providers submitted an average of $2018.57 for this code and Medicare allowed $471.78 — 4.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $372.85 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $668.68
Hospital / facility: $109.11

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 10,070 services were billed in an office setting and 5,467 in a facility.

Services: 15,537
Beneficiaries: 14,875
Providers billing it: 769
Total allowed: $7,330,046

What Medicare pays for CPT 91110

Across 15,537 services billed by 769 providers to 14,875 beneficiaries, Medicare allowed an average of $471.78 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 91110

Specialty	Services	Beneficiaries	Avg allowed	Providers
Gastroenterology	14,242	13,634	$478.86	702
Internal Medicine	883	840	$410.30	46
Physician Assistant	152	150	$445.06	8
Nurse Practitioner	108	106	$314.59	6
General Surgery	89	84	$376.80	4
Emergency Medicine	42	40	$243.35	2
General Practice	21	21	$119.76	1

91110 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
New York	1,630	$626.51	$423.62	79
California	1,600	$595.21	$394.93	66
Florida	1,361	$597.15	$484.17	65
Massachusetts	1,136	$292.80	$209.11	44
Texas	883	$499.05	$413.23	52
Georgia	795	$389.28	$330.90	29
South Carolina	654	$426.72	$360.10	34
Illinois	630	$314.64	$249.39	27
Pennsylvania	619	$478.57	$379.05	28
Maryland	396	$561.85	$409.87	20
Ohio	394	$396.74	$336.61	20
North Carolina	375	$517.76	$440.78	24
New Jersey	361	$463.64	$327.13	20
Virginia	302	$409.20	$317.24	16
Washington	287	$449.36	$341.11	19
Louisiana	279	$459.14	$417.46	16
Michigan	277	$479.19	$387.42	16
Arizona	256	$364.72	$290.12	15
Alabama	246	$440.24	$390.42	16
Tennessee	241	$471.60	$422.69	12
Missouri	229	$304.65	$258.46	15
Indiana	207	$370.17	$313.81	10
Kentucky	189	$364.07	$328.11	11
Kansas	188	$405.96	$342.13	11
Mississippi	180	$358.12	$314.21	9
Minnesota	178	$552.95	$424.26	10
Iowa	158	$269.08	$224.13	5
New Hampshire	134	$518.19	$396.87	9
Nevada	129	$691.47	$551.04	7
Colorado	126	$579.80	$458.06	7
Oklahoma	122	$314.87	$283.04	4
Rhode Island	110	$365.31	$281.13	5
Connecticut	105	$538.18	$381.84	6
Montana	104	$172.31	$132.71	5
South Dakota	90	$444.92	$373.86	5
Delaware	84	$444.29	$347.38	4
Wisconsin	78	$303.78	$254.68	6
Arkansas	76	$592.15	$546.26	4
Utah	59	$106.14	$79.91	3
Nebraska	57	$434.02	$371.65	3
West Virginia	46	$108.63	$80.20	2
North Dakota	45	$97.68	$77.96	3
Alaska	26	$801.87	$567.82	1
District of Columbia	20	$123.78	$80.26	1
New Mexico	19	$663.84	$562.38	1
Oregon	15	$673.62	$577.61	1
Wyoming	15	$107.26	$84.37	1
Vermont	14	$106.25	$84.17	1
Idaho	12	$103.59	$84.33	1

Related codes

91122Study of rectum sensitivity and function$202.62
91120Test for tone and sensation of rectum and anus$320.34

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.