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CPT code 91110 - Is a modifier required?

  1. #1
    Default CPT code 91110 - Is a modifier required?
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    A patient is in the hospital and a capsule endoscopy is performed. Code 91110 and 43258. Patient has Medicare insurance. They are denying the service due to inappropriate place of service for 91110. Any idea what to do? Thanks!!!!

  2. #2
    Default CPT code 91110
    If the facility provided the capsule, then Medicare requires a 26 modifier. The hospital should bill for the 91110 with a TC modifier.
    We are having issues with commercial payers not wanting to reimburse for this type of procedure. It has turned into a huge mess and is very costly for the patient.

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