What insurance policy changes affect CPT 91111?

There are 8 tracked policy changes affecting CPT 91111, including updates from Humana, NY Medicaid, Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 91111?

Payers that have issued tracked updates for CPT 91111 include: Humana, NY Medicaid, Excellus BlueCross BlueShield.

How do I get notified when CPT 91111 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 91111. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 91111?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

91111 — A specialized camera inserted down your throat takes pictures inside your esophagus to help doctors see and diagnose problems.: Insurance Policy Changes

91111 Insurance Policy Changes

CPT 91111, in plain terms, covers A specialized camera inserted down your throat takes pictures inside your esophagus to help doctors see and diagnose problems. CPT 91111 is referenced in 8 tracked payer policy changes from Humana, NY Medicaid, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 91111 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Update to the New York State Patient Centered Medical Home Billing Guidance

NY Medicaid·Effective Jan 1, 2026

New York State Medicaid updated Patient Centered Medical Home billing guidance effective January 1, 2026, including updated payment tables, quality reporting requirements, and provider revocation risk information. The policy also updated coverage criteria for wireless capsule endoscopy with specific billing codes and medical necessity requirements.

91111 Insurance Policy Changes

Capsule Endoscopy - Medicare Advantage (Revised)

NYRx Pharmacy Drug Coverage: Claims Processing Enhancements and Reminders

NYS Medicaid FFS Billing

Update to the New York State Patient Centered Medical Home Billing Guidance

Capsule Endoscopy 6.01.27

2026 Spousal Impoverishment Income and Resource Levels Increase

New York State Medicaid Updated Coverage Criteria for Wireless Capsule Endoscopy

Medicaid Breast Cancer Surgery Centers