91110
Gi trc img intral esoph-ile
Code typePrimary
Payment statusActive (A)
Global periodNone
Whole-Procedure Pricing
Line
Qty
Global fee
Pro fee
Primary91110Gi trc img intral esoph-ile
1
$802.29
$802.29
RVU Breakdown
Component
Office
Facility
Work
2.18
2.18
Practice expense
21.75
21.75
Malpractice
0.09
0.09
Total RVU
24.02
24.02
Payment Policy & Modifiers
Allowed adjustments
Assistant surgeon -80/81/8216% · documented
Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.
Prof / tech split -26 / -TCSplit
Has professional (-26) and technical (-TC) components, each priced separately.
Not applicable to this code
Bilateral -50Multiple procedure Co-surgeon -62Team surgeon -66