CPT code 92604: Cochlear implant programming, age 7 or older2026 Medicare rate & RVUs in South Dakota
An audiologist adjusts a cochlear implant user's processor settings for patients age 7 or older when programming changes are performed.
In South Dakota, Medicare pays $87.29 for 92604 in the office and $53.22 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 92604 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 92604 covers
An audiologist with cochlear implant expertise uses this service to adjust the processor's program or map for a patient age 7 or older. The work may include reviewing stimulation settings across channels and making changes based on the patient's listening experience, sound tolerance, or communication needs. It is commonly performed during audiology follow-up in an outpatient clinic or implant center.
Report the code when the encounter includes reprogramming, rather than diagnostic analysis alone or a visit that only reviews device function. Documentation should identify the programming work performed, the settings changed or reviewed, and the patient's response. CMS classifies this as a therapy service, and the professional component modifier does not apply; do not append modifier 26 to represent a separate professional portion.
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 South Dakota compares for 92604
Across 109 of 109 payment localities, the office rate for 92604 runs from $80.94 in Arkansas to $112.03 in San Benito County, CA. South Dakota pays $87.29. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$87.29
- Los Angeles, CA · California$97.42+$10.13
- Washington, DC area · District of Columbia$97.89+$10.60
- Miami, FL · Florida$89.88+$2.59
- Chicago, IL · Illinois$88.46+$1.17
- Manhattan, NY · New York$97.74+$10.45
- Alaska · Alaska$111.19+$23.90
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $81.69 | $51.88 |
| ArkansasArkansas | $80.94 | $51.68 |
| ArizonaArizona | $86.05 | $53.04 |
| Bakersfield, CACalifornia | $92.53 | $55.19 |
| Chico, CACalifornia | $92.43 | $55.09 |
| El Centro, CACalifornia | $92.43 | $55.09 |
| Fresno, CACalifornia | $92.43 | $55.09 |
| Hanford, CACalifornia | $92.43 | $55.09 |
| Madera, CACalifornia | $92.43 | $55.09 |
| Merced, CACalifornia | $92.43 | $55.09 |
| Modesto, CACalifornia | $92.43 | $55.09 |
| Napa, CACalifornia | $104.42 | $59.52 |
| Oxnard, CACalifornia | $96.82 | $56.55 |
| Redding, CACalifornia | $92.43 | $55.09 |
| Rest of CaliforniaCalifornia | $92.43 | $55.09 |
| Riverside, CACalifornia | $92.57 | $55.23 |
| Sacramento, CACalifornia | $96.26 | $56.64 |
| Salinas, CACalifornia | $95.87 | $56.39 |
| San Diego, CACalifornia | $97.51 | $56.77 |
| Marin County, CACalifornia | $109.92 | $61.88 |
| San Francisco, CACalifornia | $109.91 | $61.87 |
| San Benito County, CACalifornia | $112.03 | $62.90 |
| Santa Clara County, CACalifornia | $111.98 | $62.85 |
| San Luis Obispo, CACalifornia | $94.38 | $55.57 |
| Santa Cruz, CACalifornia | $98.00 | $56.60 |
| Santa Maria, CACalifornia | $96.06 | $56.34 |
| Santa Rosa, CACalifornia | $98.96 | $57.13 |
| Stockton, CACalifornia | $92.43 | $55.09 |
| Vallejo, CACalifornia | $104.41 | $59.50 |
| Visalia, CACalifornia | $92.43 | $55.09 |
| Yuba City, CACalifornia | $92.43 | $55.09 |
| ColoradoColorado | $90.85 | $54.60 |
| ConnecticutConnecticut | $91.91 | $55.22 |
| DelawareDelaware | $87.14 | $53.48 |
| Fort Lauderdale, FLFlorida | $88.37 | $53.86 |
| Rest of FloridaFlorida | $85.68 | $53.11 |
| Atlanta, GAGeorgia | $88.43 | $53.82 |
| Rest of GeorgiaGeorgia | $82.67 | $52.28 |
| Hawaii, Guam, HIHawaii | $93.59 | $54.86 |
| IowaIowa | $83.45 | $52.27 |
| IdahoIdaho | $83.70 | $52.36 |
| East St. Louis, ILIllinois | $84.22 | $52.87 |
| Rest of IllinoisIllinois | $83.75 | $52.64 |
| Suburban Chicago, ILIllinois | $89.29 | $54.30 |
| IndianaIndiana | $84.02 | $52.44 |
| KansasKansas | $82.98 | $52.19 |
| KentuckyKentucky | $82.44 | $52.15 |
| New Orleans, LALouisiana | $84.88 | $52.82 |
| Rest of LouisianaLouisiana | $82.27 | $52.12 |
| Metropolitan Boston, MAMassachusetts | $98.00 | $57.32 |
| Rest of MassachusettsMassachusetts | $90.52 | $54.64 |
| Baltimore area, MDMaryland | $91.57 | $55.02 |
| Rest of MarylandMaryland | $88.45 | $53.97 |
| Rest of MaineMaine | $83.75 | $52.41 |
| Southern Maine, MEMaine | $86.98 | $53.22 |
| Detroit, MIMichigan | $86.15 | $53.27 |
| Rest of MichiganMichigan | $83.60 | $52.50 |
| MinnesotaMinnesota | $88.59 | $53.54 |
| Metropolitan Kansas City, MOMissouri | $84.73 | $52.74 |
| Metropolitan St. Louis, MOMissouri | $85.33 | $52.90 |
| Rest of MissouriMissouri | $81.23 | $51.87 |
| MississippiMississippi | $81.11 | $51.78 |
| MontanaMontana | $87.51 | $53.44 |
| North CarolinaNorth Carolina | $84.35 | $52.56 |
| North DakotaNorth Dakota | $87.31 | $53.24 |
| NebraskaNebraska | $83.80 | $52.36 |
| New HampshireNew Hampshire | $89.33 | $53.87 |
| Northern New JerseyNew Jersey | $97.43 | $57.91 |
| Rest of New JerseyNew Jersey | $93.39 | $56.19 |
| New MexicoNew Mexico | $83.81 | $52.57 |
| NevadaNevada | $87.50 | $53.40 |
| NYC suburbs and Long Island, NYNew York | $99.05 | $58.55 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $93.77 | $56.47 |
| Queens, NYNew York | $98.60 | $58.33 |
| Rest of New YorkNew York | $85.14 | $52.77 |
| OhioOhio | $83.56 | $52.46 |
| OklahomaOklahoma | $82.58 | $52.15 |
| Portland, OROregon | $93.14 | $55.28 |
| Rest of OregonOregon | $87.23 | $53.30 |
| Metropolitan Philadelphia, PAPennsylvania | $90.19 | $54.72 |
| Rest of PennsylvaniaPennsylvania | $83.77 | $52.49 |
| Puerto RicoPuerto Rico | $88.01 | $53.56 |
| Rhode IslandRhode Island | $89.77 | $54.57 |
| South CarolinaSouth Carolina | $84.01 | $52.53 |
| TennesseeTennessee | $83.22 | $52.25 |
| Austin, TXTexas | $90.19 | $54.15 |
| Beaumont, TXTexas | $83.40 | $52.40 |
| Brazoria, TXTexas | $87.36 | $53.60 |
| Dallas, TXTexas | $87.66 | $53.72 |
| Fort Worth, TXTexas | $87.21 | $53.62 |
| Galveston, TXTexas | $87.47 | $53.64 |
| Houston, TXTexas | $87.65 | $53.82 |
| Rest of TexasTexas | $85.16 | $52.83 |
| UtahUtah | $84.75 | $52.73 |
| VirginiaVirginia | $86.64 | $53.15 |
| Virgin Islands, VIUnited States Virgin Islands | $88.01 | $53.56 |
| VermontVermont | $86.89 | $53.16 |
| Rest of WashingtonWashington | $90.38 | $54.51 |
| King County, WAWashington | $99.85 | $58.05 |
| WisconsinWisconsin | $85.37 | $52.73 |
| West VirginiaWest Virginia | $81.70 | $52.10 |
| WyomingWyoming | $87.42 | $53.35 |
92604 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.
$80.94
$111.19
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 | $111.19 | 1 |
| AL | $81.69 | 1 |
| AR | $80.94 | 1 |
| AZ | $86.05 | 1 |
| CA | $92.43–$112.03 | 29 |
| CO | $90.85 | 1 |
| CT | $91.91 | 1 |
| DC | $97.89 | 1 |
| DE | $87.14 | 1 |
| FL | $85.68–$89.88 | 3 |
| GA | $82.67–$88.43 | 2 |
| GU | $93.59 | 1 |
| HI | $93.59 | 1 |
| IA | $83.45 | 1 |
| ID | $83.70 | 1 |
| IL | $83.75–$89.29 | 4 |
| IN | $84.02 | 1 |
| KS | $82.98 | 1 |
| KY | $82.44 | 1 |
| LA | $82.27–$84.88 | 2 |
| MA | $90.52–$98.00 | 2 |
| MD | $88.45–$97.89 | 3 |
| ME | $83.75–$86.98 | 2 |
| MI | $83.60–$86.15 | 2 |
| MN | $88.59 | 1 |
| MO | $81.23–$85.33 | 3 |
| MS | $81.11 | 1 |
| MT | $87.51 | 1 |
| NC | $84.35 | 1 |
| ND | $87.31 | 1 |
| NE | $83.80 | 1 |
| NH | $89.33 | 1 |
| NJ | $93.39–$97.43 | 2 |
| NM | $83.81 | 1 |
| NV | $87.50 | 1 |
| NY | $85.14–$99.05 | 5 |
| OH | $83.56 | 1 |
| OK | $82.58 | 1 |
| OR | $87.23–$93.14 | 2 |
| PA | $83.77–$90.19 | 2 |
| PR | $88.01 | 1 |
| RI | $89.77 | 1 |
| SC | $84.01 | 1 |
| SD | $87.29 | 1 |
| TN | $83.22 | 1 |
| TX | $83.40–$90.19 | 8 |
| UT | $84.75 | 1 |
| VA | $86.64–$97.89 | 2 |
| VI | $88.01 | 1 |
| VT | $86.89 | 1 |
| WA | $90.38–$99.85 | 2 |
| WI | $85.37 | 1 |
| WV | $81.70 | 1 |
| WY | $87.42 | 1 |
How the 92604 rate is calculated
Each of 92604’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 · 92604
RVUs × geographic indexes × conversion factor
Work1.25
1.25 RVUs× 1.000 GPCI
Practice expense1.36
1.36 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
2.6200
Conversion factor
$33.4009
Medicare rate
$87.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact South Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
11,862
- Code
- 92604
- Physician work
- 1.25
- Practice expense
- 1.36
- Malpractice
- 0.01
GPCI2026.csv
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.25 | × 1.000 | 1.2500 |
| Practice expense | 1.36 | × 1.000 | 1.3600 |
| Malpractice | 0.01 | × 0.336 | 0.0034 |
| Total RVUs | 2.6134 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$87.29
Office: (1.25 × 1 + 1.36 × 1 + 0.01 × 0.336) × $33.4009 = $87.29
Facility: (1.25 × 1 + 0.34 × 1 + 0.01 × 0.336) × $33.4009 = $53.22
Payment rules and modifiers for 92604
The CMS indicators that decide how 92604 is paid alongside other services.
CMS payment indicators · 92604
Cochlear implant programming, age 7 or older
| 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) | 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 | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
92604 without CQ · national office
$87.51
Cochlear implant programming, age 7 or older
92604-CQ · Allowed amount unchanged
$87.51
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 92604 has changed in South Dakota
92604 · Office / nonfacility
$87.29
Effective 2026-10-01
The base rate is $1.52 higher than on 2025-10-01, moving from $85.77 to $87.29 (1.8%).
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
$85.77changed to$87.29
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 1.39 changed to 1.36
- Malpractice RVU 0.03 changed to 0.01
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$88.59changed to$85.77
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.40 changed to 1.39
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$87.15changed to$88.59
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$91.31changed to$87.15
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.43 changed to 1.40
- Malpractice RVU 0.04 changed to 0.03
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$93.00changed to$91.31
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.42 changed to 1.43
- Malpractice RVU 0.05 changed to 0.04
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$94.82changed to$93.00
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.45 changed to 1.42
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$94.14changed to$94.82
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.34 changed to 1.45
- Malpractice GPCI 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$92.60changed to$94.14
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.30 changed to 1.34
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$91.42changed to$92.60
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.27 changed to 1.30
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$90.43changed to$91.42
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.25 changed to 1.27
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$89.51changed to$90.43
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.23 changed to 1.25
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$88.97changed to$89.51
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 1.21 changed to 1.23
- Malpractice RVU 0.04 changed to 0.05
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$88.53changed to$88.97
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$88.51changed to$88.53
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.20 changed to 1.21
- Malpractice RVU 0.05 changed to 0.04
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
$87.49changed to$88.51
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.30 changed to 1.20
- Malpractice GPCI 0.432 changed to 0.416
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $87.49
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $87.29 | $53.22 | RVU26D |
| 2026-07-01 | $87.29 | $53.22 | RVU26C |
| 2026-04-01 | $87.29 | $53.22 | RVU26B |
| 2026-01-01 | $87.29 | $53.22 | RVU26A |
| 2025-10-01 | $85.77 | $63.12 | RVU25D |
| 2025-07-01 | $85.77 | $63.12 | RVU25C |
| 2025-04-01 | $85.77 | $63.12 | RVU25B |
| 2025-01-01 | $85.77 | $63.12 | RVU25A |
| 2024-10-01 | $88.59 | $64.29 | RVU24D |
| 2024-07-01 | $88.59 | $64.29 | RVU24C |
| 2024-04-01 | $88.59 | $64.29 | RVU24B |
| 2024-03-09 | $88.59 | $64.29 | RVU24AR |
| 2024-01-01 | $87.15 | $63.24 | RVU24A |
| 2023-10-01 | $91.31 | $65.90 | RVU23D |
| 2023-07-01 | $91.31 | $65.90 | RVU23C |
| 2023-04-01 | $91.31 | $65.90 | RVU23B |
| 2023-01-01 | $91.31 | $65.90 | RVU23A |
| 2022-10-01 | $93.00 | $66.70 | RVU22D |
| 2022-07-01 | $93.00 | $66.70 | RVU22C |
| 2022-04-01 | $93.00 | $66.70 | RVU22B |
| 2022-01-01 | $93.00 | $66.70 | RVU22A |
| 2021-10-01 | $94.82 | $67.25 | RVU21D |
| 2021-07-01 | $94.82 | $67.25 | RVU21C |
| 2021-04-01 | $94.82 | $67.25 | RVU21B |
| 2021-01-01 | $94.82 | $67.25 | RVU21A |
| 2020-10-01 | $94.14 | $68.87 | RVU20D |
| 2020-07-01 | $94.14 | $68.87 | RVU20C |
| 2020-04-01 | $94.14 | $68.87 | RVU20B |
| 2020-01-01 | $94.14 | $68.87 | RVU20A |
| 2019-10-01 | $92.60 | $68.81 | RVU19D |
| 2019-07-01 | $92.60 | $68.81 | RVU19C |
| 2019-04-01 | $92.60 | $68.81 | RVU19B |
| 2019-01-01 | $92.60 | $68.81 | RVU19A |
| 2018-10-01 | $91.42 | $68.74 | RVU18D |
| 2018-07-01 | $91.42 | $68.74 | RVU18C |
| 2018-04-01 | $91.42 | $68.74 | RVU18B |
| 2018-01-01 | $91.42 | $68.74 | RVU18AR1 |
| 2017-10-01 | $90.43 | $68.18 | RVU17D |
| 2017-07-01 | $90.43 | $68.18 | RVU17C |
| 2017-04-01 | $90.43 | $68.18 | RVU17B |
| 2017-01-01 | $90.43 | $68.18 | RVU17A |
| 2016-10-01 | $89.51 | $67.67 | RVU16D |
| 2016-07-01 | $89.51 | $67.67 | RVU16C |
| 2016-04-01 | $89.51 | $67.67 | RVU16B |
| 2016-01-01 | $89.51 | $67.67 | RVU16A |
| 2015-10-01 | $88.97 | $67.77 | RVU15D |
| 2015-07-01 | $88.97 | $67.77 | RVU15C |
| 2015-04-01 | $88.53 | $67.43 | RVU15B |
| 2015-01-01 | $88.53 | $67.43 | RVU15A |
| 2014-10-01 | $88.51 | $67.73 | RVU14D |
| 2014-07-01 | $88.51 | $67.73 | RVU14C |
| 2014-04-01 | $88.51 | $67.73 | RVU14B |
| 2014-01-01 | $88.51 | $67.73 | RVU14A |
| 2013-10-01 | $87.49 | $65.72 | RVU13D |
| 2013-07-01 | $87.49 | $65.72 | RVU13C |
| 2013-04-01 | $87.49 | $65.72 | RVU13B |
| 2013-01-01 | $87.49 | $65.72 | RVU13AR |
Where the South Dakota rate applies
South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Agar
- Agency Village
- Akaska
- Albee
- Alcester
- Alexandria
- Allen
92604 billing questions
How does this differ from 92603?
92604 represents processor reprogramming for a patient age 7 or older. 92603 is used for diagnostic analysis of a cochlear implant in this age group.
When should 92602 be used instead?
92602 describes cochlear implant reprogramming for a patient younger than 7. Use 92604 for patients age 7 or older.
Can modifier 26 be appended?
No. CMS identifies this as a therapy service for which the professional component modifier does not apply.
What documentation supports reporting reprogramming?
Document the programming performed, the processor settings reviewed or changed, and the patient's response or reason for the adjustment. A note describing diagnostic analysis alone supports a different service.
Is this a timed code or billed by electrode?
It is not a timed code. Report the reprogramming service, not a separate unit for each electrode or setting adjustment.
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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