CPT code 92568: Acoustic reflex, threshold measurement2026 Medicare rate & RVUs in Hawaii, Guam, HI
Reports measurement of the sound level that triggers an acoustic reflex, typically during diagnostic evaluation of hearing or middle-ear function.
In Hawaii, Guam, HI, Medicare pays $15.96 for 92568 in the office and $12.92 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 92568 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 92568 covers
An audiologist typically uses immittance equipment to measure the sound level that elicits an involuntary middle-ear muscle response. The test may be included in an outpatient diagnostic hearing evaluation when reflex thresholds help interpret auditory or middle-ear findings. Results are recorded by ear and can be considered alongside tympanometry and audiometry.
Report 92568 for the reflex-threshold measurement itself, rather than tympanometry alone or a broader immittance service that includes this measurement. Documentation should identify the ears tested, test conditions, measured thresholds or absent responses, and relevant interpretation. CMS prices the service on a bilateral basis, so modifier 50 does not increase payment. CMS identifies this as a therapy service; the professional component modifier does not apply.
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.
How Hawaii, Guam, HI compares for 92568
Across 109 of 109 payment localities, the office rate for 92568 runs from $14.45 in Arkansas to $20.40 in Alaska. Hawaii, Guam, HI pays $15.96. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Hawaii, Guam, HI · this page$15.96
- Los Angeles, CA · California$16.63+$0.67
- Washington, DC area · District of Columbia$16.88+$0.92
- Miami, FL · Florida$16.09+$0.13
- Chicago, IL · Illinois$15.89−$0.07
- Manhattan, NY · New York$17.05+$1.09
- Alaska · Alaska$20.40+$4.44
Other areas in Hawaii first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $14.55 | $12.21 |
| ArkansasArkansas | $14.45 | $12.15 |
| ArizonaArizona | $15.15 | $12.56 |
| Bakersfield, CACalifornia | $15.93 | $13.00 |
| Chico, CACalifornia | $15.89 | $12.96 |
| El Centro, CACalifornia | $15.89 | $12.96 |
| Fresno, CACalifornia | $15.89 | $12.96 |
| Hanford, CACalifornia | $15.89 | $12.96 |
| Madera, CACalifornia | $15.89 | $12.96 |
| Merced, CACalifornia | $15.89 | $12.96 |
| Modesto, CACalifornia | $15.89 | $12.96 |
| Napa, CACalifornia | $17.51 | $13.99 |
| Oxnard, CACalifornia | $16.48 | $13.32 |
| Redding, CACalifornia | $15.89 | $12.96 |
| Rest of CaliforniaCalifornia | $15.89 | $12.96 |
| Riverside, CACalifornia | $16.00 | $13.07 |
| Sacramento, CACalifornia | $16.43 | $13.32 |
| Salinas, CACalifornia | $16.36 | $13.26 |
| San Diego, CACalifornia | $16.55 | $13.35 |
| Marin County, CACalifornia | $18.30 | $14.53 |
| San Francisco, CACalifornia | $18.28 | $14.52 |
| San Benito County, CACalifornia | $18.64 | $14.78 |
| Santa Clara County, CACalifornia | $18.59 | $14.74 |
| San Luis Obispo, CACalifornia | $16.12 | $13.07 |
| Santa Cruz, CACalifornia | $16.56 | $13.32 |
| Santa Maria, CACalifornia | $16.37 | $13.25 |
| Santa Rosa, CACalifornia | $16.72 | $13.44 |
| Stockton, CACalifornia | $15.89 | $12.96 |
| Vallejo, CACalifornia | $17.49 | $13.97 |
| Visalia, CACalifornia | $15.89 | $12.96 |
| Yuba City, CACalifornia | $15.89 | $12.96 |
| ColoradoColorado | $15.75 | $12.91 |
| ConnecticutConnecticut | $16.04 | $13.16 |
| DelawareDelaware | $15.31 | $12.67 |
| Fort Lauderdale, FLFlorida | $15.70 | $13.00 |
| Rest of FloridaFlorida | $15.30 | $12.74 |
| Atlanta, GAGeorgia | $15.55 | $12.83 |
| Rest of GeorgiaGeorgia | $14.85 | $12.47 |
| IowaIowa | $14.71 | $12.26 |
| IdahoIdaho | $14.76 | $12.30 |
| East St. Louis, ILIllinois | $15.28 | $12.82 |
| Rest of IllinoisIllinois | $15.09 | $12.65 |
| Suburban Chicago, ILIllinois | $15.83 | $13.09 |
| IndianaIndiana | $14.80 | $12.33 |
| KansasKansas | $14.69 | $12.27 |
| KentuckyKentucky | $14.74 | $12.37 |
| New Orleans, LALouisiana | $15.09 | $12.58 |
| Rest of LouisianaLouisiana | $14.74 | $12.37 |
| Metropolitan Boston, MAMassachusetts | $16.76 | $13.57 |
| Rest of MassachusettsMassachusetts | $15.73 | $12.92 |
| Baltimore area, MDMaryland | $15.99 | $13.12 |
| Rest of MarylandMaryland | $15.50 | $12.79 |
| Rest of MaineMaine | $14.81 | $12.35 |
| Southern Maine, MEMaine | $15.19 | $12.55 |
| Detroit, MIMichigan | $15.41 | $12.83 |
| Rest of MichiganMichigan | $14.94 | $12.50 |
| MinnesotaMinnesota | $15.28 | $12.53 |
| Metropolitan Kansas City, MOMissouri | $15.03 | $12.52 |
| Metropolitan St. Louis, MOMissouri | $15.11 | $12.56 |
| Rest of MissouriMissouri | $14.62 | $12.31 |
| MississippiMississippi | $14.53 | $12.23 |
| MontanaMontana | $15.36 | $12.69 |
| North CarolinaNorth Carolina | $14.89 | $12.39 |
| North DakotaNorth Dakota | $15.17 | $12.49 |
| NebraskaNebraska | $14.75 | $12.28 |
| New HampshireNew Hampshire | $15.54 | $12.76 |
| Northern New JerseyNew Jersey | $16.85 | $13.75 |
| Rest of New JerseyNew Jersey | $16.28 | $13.36 |
| New MexicoNew Mexico | $14.99 | $12.54 |
| NevadaNevada | $15.31 | $12.64 |
| NYC suburbs and Long Island, NYNew York | $17.28 | $14.10 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $16.38 | $13.45 |
| Queens, NYNew York | $17.10 | $13.95 |
| Rest of New YorkNew York | $15.00 | $12.46 |
| OhioOhio | $14.90 | $12.46 |
| OklahomaOklahoma | $14.72 | $12.33 |
| Portland, OROregon | $16.03 | $13.06 |
| Rest of OregonOregon | $15.24 | $12.58 |
| Metropolitan Philadelphia, PAPennsylvania | $15.82 | $13.04 |
| Rest of PennsylvaniaPennsylvania | $14.91 | $12.45 |
| Puerto RicoPuerto Rico | $15.42 | $12.72 |
| Rhode IslandRhode Island | $15.69 | $12.93 |
| South CarolinaSouth Carolina | $14.91 | $12.44 |
| South DakotaSouth Dakota | $15.14 | $12.47 |
| TennesseeTennessee | $14.72 | $12.29 |
| Austin, TXTexas | $15.66 | $12.83 |
| Beaumont, TXTexas | $14.86 | $12.43 |
| Brazoria, TXTexas | $15.32 | $12.67 |
| Dallas, TXTexas | $15.38 | $12.72 |
| Fort Worth, TXTexas | $15.33 | $12.70 |
| Galveston, TXTexas | $15.35 | $12.69 |
| Houston, TXTexas | $15.53 | $12.88 |
| Rest of TexasTexas | $15.06 | $12.52 |
| UtahUtah | $15.01 | $12.50 |
| VirginiaVirginia | $15.18 | $12.55 |
| Virgin Islands, VIUnited States Virgin Islands | $15.42 | $12.72 |
| VermontVermont | $15.15 | $12.50 |
| Rest of WashingtonWashington | $15.69 | $12.88 |
| King County, WAWashington | $17.00 | $13.72 |
| WisconsinWisconsin | $14.91 | $12.35 |
| West VirginiaWest Virginia | $14.81 | $12.49 |
| WyomingWyoming | $15.28 | $12.61 |
92568 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$14.45
$20.40
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $20.40 | 1 |
| AL | $14.55 | 1 |
| AR | $14.45 | 1 |
| AZ | $15.15 | 1 |
| CA | $15.89–$18.64 | 29 |
| CO | $15.75 | 1 |
| CT | $16.04 | 1 |
| DC | $16.88 | 1 |
| DE | $15.31 | 1 |
| FL | $15.30–$16.09 | 3 |
| GA | $14.85–$15.55 | 2 |
| GU | $15.96 | 1 |
| HI | $15.96 | 1 |
| IA | $14.71 | 1 |
| ID | $14.76 | 1 |
| IL | $15.09–$15.89 | 4 |
| IN | $14.80 | 1 |
| KS | $14.69 | 1 |
| KY | $14.74 | 1 |
| LA | $14.74–$15.09 | 2 |
| MA | $15.73–$16.76 | 2 |
| MD | $15.50–$16.88 | 3 |
| ME | $14.81–$15.19 | 2 |
| MI | $14.94–$15.41 | 2 |
| MN | $15.28 | 1 |
| MO | $14.62–$15.11 | 3 |
| MS | $14.53 | 1 |
| MT | $15.36 | 1 |
| NC | $14.89 | 1 |
| ND | $15.17 | 1 |
| NE | $14.75 | 1 |
| NH | $15.54 | 1 |
| NJ | $16.28–$16.85 | 2 |
| NM | $14.99 | 1 |
| NV | $15.31 | 1 |
| NY | $15.00–$17.28 | 5 |
| OH | $14.90 | 1 |
| OK | $14.72 | 1 |
| OR | $15.24–$16.03 | 2 |
| PA | $14.91–$15.82 | 2 |
| PR | $15.42 | 1 |
| RI | $15.69 | 1 |
| SC | $14.91 | 1 |
| SD | $15.14 | 1 |
| TN | $14.72 | 1 |
| TX | $14.86–$15.66 | 8 |
| UT | $15.01 | 1 |
| VA | $15.18–$16.88 | 2 |
| VI | $15.42 | 1 |
| VT | $15.15 | 1 |
| WA | $15.69–$17.00 | 2 |
| WI | $14.91 | 1 |
| WV | $14.81 | 1 |
| WY | $15.28 | 1 |
How the 92568 rate is calculated
Each of 92568’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 · 92568
RVUs × geographic indexes × conversion factor
Work0.29
0.29 RVUs× 1.000 GPCI
Practice expense0.16
0.16 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.4600
Conversion factor
$33.4009
Medicare rate
$15.36
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Hawaii, Guam, HI inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
11,840
- Code
- 92568
- Physician work
- 0.29
- Practice expense
- 0.16
- Malpractice
- 0.01
GPCI2026.csv
46
- Locality
- Hawaii, Guam, HI
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.29 | × 1.000 | 0.2900 |
| Practice expense | 0.16 | × 1.137 | 0.1819 |
| Malpractice | 0.01 | × 0.579 | 0.0058 |
| Total RVUs | 0.4777 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Hawaii, Guam, HI$15.96
Office: (0.29 × 1 + 0.16 × 1.137 + 0.01 × 0.579) × $33.4009 = $15.96
Facility: (0.29 × 1 + 0.08 × 1.137 + 0.01 × 0.579) × $33.4009 = $12.92
Payment rules and modifiers for 92568
The CMS indicators that decide how 92568 is paid alongside other services.
CMS payment indicators · 92568
Acoustic reflex, threshold measurement
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 2 | Already bilateral by definition: paid once at 100%. |
| 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 | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
92568 without CQ · national office
$15.36
Acoustic reflex, threshold measurement
92568-CQ · Allowed amount unchanged
$15.36
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
How 92568 has changed in Hawaii, Guam, HI
92568 · Office / nonfacility
$15.96
Effective 2026-10-01
The base rate is $0.82 higher than on 2025-10-01, moving from $15.14 to $15.96 (5.4%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$15.14changed to$15.96
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.15 changed to 0.16
- Practice expense GPCI 1.149 changed to 1.137
- Malpractice GPCI 0.561 changed to 0.579
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$15.58changed to$15.14
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$15.32changed to$15.58
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$16.10changed to$15.32
- Conversion factor 33.8872 changed to 32.7442
- Malpractice RVU 0.02 changed to 0.01
- Work GPCI 1.003 changed to 1.000
- Practice expense GPCI 1.146 changed to 1.149
- Malpractice GPCI 0.618 changed to 0.561
January 1, 2023
RVU23A
$16.54changed to$16.10
- Conversion factor 34.6062 changed to 33.8872
- Work GPCI 1.010 changed to 1.003
- Practice expense GPCI 1.143 changed to 1.146
- Malpractice GPCI 0.675 changed to 0.618
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$16.27changed to$16.54
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.14 changed to 0.15
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$16.77changed to$16.27
- Conversion factor 36.0896 changed to 34.8931
- Work GPCI 1.006 changed to 1.010
- Practice expense GPCI 1.144 changed to 1.143
- Malpractice GPCI 0.644 changed to 0.675
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$16.69changed to$16.77
- Conversion factor 36.0391 changed to 36.0896
- Work GPCI 1.001 changed to 1.006
- Practice expense GPCI 1.146 changed to 1.144
- Malpractice GPCI 0.614 changed to 0.644
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$16.67changed to$16.69
- Conversion factor 35.9996 changed to 36.0391
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$16.67changed to$16.67
- Conversion factor 35.8887 changed to 35.9996
- Work GPCI 1.002 changed to 1.001
- Practice expense GPCI 1.154 changed to 1.146
- Malpractice GPCI 0.616 changed to 0.614
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$16.68changed to$16.67
- Conversion factor 35.8043 changed to 35.8887
- Work GPCI 1.003 changed to 1.002
- Practice expense GPCI 1.162 changed to 1.154
- Malpractice GPCI 0.618 changed to 0.616
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$16.52changed to$16.68
- Conversion factor 35.9335 changed to 35.8043
- Malpractice RVU 0.01 changed to 0.02
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$16.44changed to$16.52
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$16.45changed to$16.44
- Conversion factor 35.8228 changed to 35.7547
- Work GPCI 1.002 changed to 1.003
- Practice expense GPCI 1.158 changed to 1.162
- Malpractice GPCI 0.659 changed to 0.618
Held through RVU15B.
January 1, 2014
RVU14A
$15.99changed to$16.45
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 0.15 changed to 0.14
- Work GPCI 1.000 changed to 1.002
- Practice expense GPCI 1.154 changed to 1.158
- Malpractice GPCI 0.700 changed to 0.659
Held through RVU14B, RVU14C, RVU14D.
October 1, 2013
RVU13D
No ratechanged to$15.99
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $15.96 | $12.92 | RVU26D |
| 2026-07-01 | $15.96 | $12.92 | RVU26C |
| 2026-04-01 | $15.96 | $12.92 | RVU26B |
| 2026-01-01 | $15.96 | $12.92 | RVU26A |
| 2025-10-01 | $15.14 | $15.14 | RVU25D |
| 2025-07-01 | $15.14 | $15.14 | RVU25C |
| 2025-04-01 | $15.14 | $15.14 | RVU25B |
| 2025-01-01 | $15.14 | $15.14 | RVU25A |
| 2024-10-01 | $15.58 | $15.19 | RVU24D |
| 2024-07-01 | $15.58 | $15.19 | RVU24C |
| 2024-04-01 | $15.58 | $15.19 | RVU24B |
| 2024-03-09 | $15.58 | $15.19 | RVU24AR |
| 2024-01-01 | $15.32 | $14.95 | RVU24A |
| 2023-10-01 | $16.10 | $15.71 | RVU23D |
| 2023-07-01 | $16.10 | $15.71 | RVU23C |
| 2023-04-01 | $16.10 | $15.71 | RVU23B |
| 2023-01-01 | $16.10 | $15.71 | RVU23A |
| 2022-10-01 | $16.54 | $16.14 | RVU22D |
| 2022-07-01 | $16.54 | $16.14 | RVU22C |
| 2022-04-01 | $16.54 | $16.14 | RVU22B |
| 2022-01-01 | $16.54 | $16.14 | RVU22A |
| 2021-10-01 | $16.27 | $15.88 | RVU21D |
| 2021-07-01 | $16.27 | $15.88 | RVU21C |
| 2021-04-01 | $16.27 | $15.88 | RVU21B |
| 2021-01-01 | $16.27 | $15.88 | RVU21A |
| 2020-10-01 | $16.77 | $16.36 | RVU20D |
| 2020-07-01 | $16.77 | $16.36 | RVU20C |
| 2020-04-01 | $16.77 | $16.36 | RVU20B |
| 2020-01-01 | $16.77 | $16.36 | RVU20A |
| 2019-10-01 | $16.69 | $16.27 | RVU19D |
| 2019-07-01 | $16.69 | $16.27 | RVU19C |
| 2019-04-01 | $16.69 | $16.27 | RVU19B |
| 2019-01-01 | $16.69 | $16.27 | RVU19A |
| 2018-10-01 | $16.67 | $16.26 | RVU18D |
| 2018-07-01 | $16.67 | $16.26 | RVU18C |
| 2018-04-01 | $16.67 | $16.26 | RVU18B |
| 2018-01-01 | $16.67 | $16.26 | RVU18AR1 |
| 2017-10-01 | $16.67 | $16.25 | RVU17D |
| 2017-07-01 | $16.67 | $16.25 | RVU17C |
| 2017-04-01 | $16.67 | $16.25 | RVU17B |
| 2017-01-01 | $16.67 | $16.25 | RVU17A |
| 2016-10-01 | $16.68 | $16.27 | RVU16D |
| 2016-07-01 | $16.68 | $16.27 | RVU16C |
| 2016-04-01 | $16.68 | $16.27 | RVU16B |
| 2016-01-01 | $16.68 | $16.27 | RVU16A |
| 2015-10-01 | $16.52 | $16.10 | RVU15D |
| 2015-07-01 | $16.52 | $16.10 | RVU15C |
| 2015-04-01 | $16.44 | $16.02 | RVU15B |
| 2015-01-01 | $16.44 | $16.02 | RVU15A |
| 2014-10-01 | $16.45 | $16.45 | RVU14D |
| 2014-07-01 | $16.45 | $16.45 | RVU14C |
| 2014-04-01 | $16.45 | $16.45 | RVU14B |
| 2014-01-01 | $16.45 | $16.45 | RVU14A |
| 2013-10-01 | $15.99 | $15.99 | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Hawaii, Guam, HI rate applies
Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.
- Ahuimanu
- Aiea
- Ainaloa
- Anahola
- Black Sands
- Captain Cook
- Discovery Harbour
- East Honolulu
92568 billing questions
How is 92568 different from tympanometry?
92568 measures the sound level that elicits an acoustic reflex. Tympanometry, reported with 92567, assesses middle-ear pressure and mobility.
Should 92568 be reported with 92550?
92550 represents tympanometry together with reflex-threshold measurements. When both services are performed as that combined service, compare 92550 with reporting the individual tests.
How does 92568 differ from 92570?
92570 describes a broader acoustic immittance service that includes reflex-threshold measurement. Use 92568 when reporting the threshold test itself, rather than the broader service.
Should modifier 50 be appended?
CMS prices 92568 as bilateral. Modifier 50 does not increase payment.
Can modifier 26 be used for the professional work?
No. CMS identifies this as a therapy service for which the professional component modifier does not apply.
What should the record include?
Document the ears tested, test conditions, measured thresholds or absent responses, and the interpretation of the findings.
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
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