CPT code 92511: Nasopharyngoscopy, endoscopic nasopharynx exam2026 Medicare rate & RVUs in Illinois
Reports endoscopic visualization of the nasopharynx, commonly used by an ENT clinician to evaluate obstruction, adenoid tissue, or a suspected lesion.
Medicare pays $108.40–$119.63 for 92511 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 92511 covers
An ENT clinician typically passes a flexible or rigid endoscope through a nostril to examine the posterior nasal space and nasopharynx, including the area around the eustachian tube openings. Common reasons include persistent nasal obstruction, suspected adenoid enlargement, a visible or suspected nasopharyngeal lesion, or evaluation of unilateral middle-ear effusion. The service may be performed in an office or facility setting.
Report 92511 when the documented examination visualizes the nasopharynx; an examination limited to the nasal cavity or directed at the larynx represents a different service. The record should identify the indication, endoscopic approach, structures examined, and findings. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 92511 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$108.40 to $119.63
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $118.24 | $34.66 |
| East St. Louis, IL | $109.67 | $33.15 |
| Rest of Illinois | $108.40 | $32.47 |
| Suburban Chicago, IL | $119.63 | $34.22 |
How the 92511 rate is calculated
Each of 92511’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 92511
RVUs × geographic indexes × conversion factor
Work0.59
0.59 RVUs× 1.000 GPCI
Practice expense2.84
2.84 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
3.4700
Conversion factor
$33.4009
Medicare rate
$115.90
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92511
The CMS indicators that decide how 92511 is paid alongside other services.
CMS payment indicators · 92511
Nasopharyngoscopy, endoscopic nasopharynx exam
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
92511 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 31231Nasal endoscopyDiagnostic, without sinusoscopy
- Use 92511 when the endoscopic examination includes the nasopharynx. Use 31231 for diagnostic endoscopic examination focused on the nasal cavity.
- 92512Nasal function testAirflow and resistance
- 92512 represents nasal function testing, not endoscopic visualization. Choose 92511 when the service is direct examination of the nasopharynx.
- 31575LaryngoscopyFlexible, diagnostic
- 31575 examines the larynx by flexible endoscopy. 92511 is for visualization of the nasopharynx, a different anatomic target.
92511 billing questions
How is 92511 different from diagnostic nasal endoscopy?
92511 is selected when the documented endoscopic examination reaches the nasopharynx. A nasal endoscopy code such as 31231 is directed to examination of the nasal cavity.
Can modifier 50 be used when both sides are examined?
No. CMS identifies bilateral adjustment as inappropriate for 92511; do not use modifier 50 to represent examination through both nostrils.
What documentation supports reporting 92511?
Document the clinical reason for the examination, the endoscopic approach, the nasopharyngeal structures visualized, and the findings. The note should support that the examination extended beyond the nasal cavity.
Is same-day preoperative or postoperative care included?
Yes. The code has a 0-day global period, which includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documented medical necessity. CMS does not permit co-surgeons or team surgery for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 92511 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →