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CPT code 92604: Cochlear implant programming, age 7 or older2026 Medicare rate & RVUs in West Virginia

An audiologist adjusts a cochlear implant user's processor settings for patients age 7 or older when programming changes are performed.

CMS RVU26DEffective Oct 1, 2026One payment locality29.1K Medicare services in 2024

In West Virginia, Medicare pays $81.70 for 92604 in the office and $52.10 when it’s performed in a hospital or facility.

$81.70Office (non-facility)
$52.10Hospital or facility
−6.6%vs the national office rate ($87.51)

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.

We’ll open 92604 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in West Virginia
  2. What 92604 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 West Virginia 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. West Virginia pays $81.70. The RVUs are the same everywhere; the geographic indexes change the dollars.

92604 in West Virginia vs other payment areas
  1. West Virginia · this page$81.70
  2. Los Angeles, CA · California$97.42+$15.72
  3. Washington, DC area · District of Columbia$97.89+$16.19
  4. Miami, FL · Florida$89.88+$8.18
  5. Chicago, IL · Illinois$88.46+$6.76
  6. Manhattan, NY · New York$97.74+$16.04
  7. Alaska · Alaska$111.19+$29.49

Other areas in West Virginia first, then benchmark localities. Bars start at $0.

Every other payment area

92604 in every other Medicare payment locality
Payment localityOfficeFacility
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

92604 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
92604 office rate range by state
State / territoryOffice rate rangeLocalities
AK$111.191
AL$81.691
AR$80.941
AZ$86.051
CA$92.43–$112.0329
CO$90.851
CT$91.911
DC$97.891
DE$87.141
FL$85.68–$89.883
GA$82.67–$88.432
GU$93.591
HI$93.591
IA$83.451
ID$83.701
IL$83.75–$89.294
IN$84.021
KS$82.981
KY$82.441
LA$82.27–$84.882
MA$90.52–$98.002
MD$88.45–$97.893
ME$83.75–$86.982
MI$83.60–$86.152
MN$88.591
MO$81.23–$85.333
MS$81.111
MT$87.511
NC$84.351
ND$87.311
NE$83.801
NH$89.331
NJ$93.39–$97.432
NM$83.811
NV$87.501
NY$85.14–$99.055
OH$83.561
OK$82.581
OR$87.23–$93.142
PA$83.77–$90.192
PR$88.011
RI$89.771
SC$84.011
SD$87.291
TN$83.221
TX$83.40–$90.198
UT$84.751
VA$86.64–$97.892
VI$88.011
VT$86.891
WA$90.38–$99.852
WI$85.371
WV$81.701
WY$87.421

See 92604 in every payment locality

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

Office or facility?

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 West Virginia 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

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 92604 in West Virginia
ComponentRVULocality factorAdjusted
Physician work1.25× 1.0001.2500
Practice expense1.36× 0.8691.1818
Malpractice0.01× 1.4310.0143
Total RVUs2.4462
Conversion factor× 33.4009

Office rate, West Virginia$81.70

Office: (1.25 × 1 + 1.36 × 0.869 + 0.01 × 1.431) × $33.4009 = $81.70

Facility: (1.25 × 1 + 0.34 × 0.869 + 0.01 × 1.431) × $33.4009 = $52.10

Open 92604 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical7Therapy 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.

Codes related to 92604

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 92604
CodeHow it relatesOffice range, West Virginia
Used instead
92602Implant reprogramming, subsequent, under age 7Reprogramming service for patients younger than 7.$90.34
Same family
92603Implant analysis, age seven or olderDiagnostic analysis of a cochlear implant for patients age 7 or older.$136.58
92601Cochlear implant, diagnostic analysis, under age 7Diagnostic analysis of a cochlear implant for patients younger than 7.$144.35

How 92604 has changed in West Virginia

92604 · Office / nonfacility

$81.70

Effective 2026-10-01

The base rate is $1.22 higher than on 2025-10-01, moving from $80.48 to $81.70 (1.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $80.48changed to$81.70

    • 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
    • Practice expense GPCI 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $83.11changed to$80.48

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.40 changed to 1.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $81.76changed to$83.11

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $85.75changed to$81.76

    • 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
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $87.49changed to$85.75

    • 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
    • Practice expense GPCI 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $89.12changed to$87.49

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.45 changed to 1.42

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $88.81changed to$89.12

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.34 changed to 1.45
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $87.54changed to$88.81

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.30 changed to 1.34
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $86.51changed to$87.54

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.27 changed to 1.30

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $85.17changed to$86.51

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.25 changed to 1.27
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $83.87changed to$85.17

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.23 changed to 1.25
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $83.11changed to$83.87

    • 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.

  13. July 1, 2015

    RVU15C

    $82.69changed to$83.11

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $82.79changed to$82.69

    • 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
    • Practice expense GPCI 0.832 changed to 0.836
    • Malpractice GPCI 1.256 changed to 1.282

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $81.24changed to$82.79

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.30 changed to 1.20
    • Practice expense GPCI 0.828 changed to 0.832
    • Malpractice GPCI 1.229 changed to 1.256

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $81.24

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$81.70$52.10RVU26D
2026-07-01$81.70$52.10RVU26C
2026-04-01$81.70$52.10RVU26B
2026-01-01$81.70$52.10RVU26A
2025-10-01$80.48$60.97RVU25D
2025-07-01$80.48$60.97RVU25C
2025-04-01$80.48$60.97RVU25B
2025-01-01$80.48$60.97RVU25A
2024-10-01$83.11$62.17RVU24D
2024-07-01$83.11$62.17RVU24C
2024-04-01$83.11$62.17RVU24B
2024-03-09$83.11$62.17RVU24AR
2024-01-01$81.76$61.15RVU24A
2023-10-01$85.75$63.89RVU23D
2023-07-01$85.75$63.89RVU23C
2023-04-01$85.75$63.89RVU23B
2023-01-01$85.75$63.89RVU23A
2022-10-01$87.49$64.93RVU22D
2022-07-01$87.49$64.93RVU22C
2022-04-01$87.49$64.93RVU22B
2022-01-01$87.49$64.93RVU22A
2021-10-01$89.12$65.47RVU21D
2021-07-01$89.12$65.47RVU21C
2021-04-01$89.12$65.47RVU21B
2021-01-01$89.12$65.47RVU21A
2020-10-01$88.81$67.16RVU20D
2020-07-01$88.81$67.16RVU20C
2020-04-01$88.81$67.16RVU20B
2020-01-01$88.81$67.16RVU20A
2019-10-01$87.54$67.15RVU19D
2019-07-01$87.54$67.15RVU19C
2019-04-01$87.54$67.15RVU19B
2019-01-01$87.54$67.15RVU19A
2018-10-01$86.51$67.08RVU18D
2018-07-01$86.51$67.08RVU18C
2018-04-01$86.51$67.08RVU18B
2018-01-01$86.51$67.08RVU18AR1
2017-10-01$85.17$66.32RVU17D
2017-07-01$85.17$66.32RVU17C
2017-04-01$85.17$66.32RVU17B
2017-01-01$85.17$66.32RVU17A
2016-10-01$83.87$65.61RVU16D
2016-07-01$83.87$65.61RVU16C
2016-04-01$83.87$65.61RVU16B
2016-01-01$83.87$65.61RVU16A
2015-10-01$83.11$65.38RVU15D
2015-07-01$83.11$65.38RVU15C
2015-04-01$82.69$65.06RVU15B
2015-01-01$82.69$65.06RVU15A
2014-10-01$82.79$65.51RVU14D
2014-07-01$82.79$65.51RVU14C
2014-04-01$82.79$65.51RVU14B
2014-01-01$82.79$65.51RVU14A
2013-10-01$81.24$63.21RVU13D
2013-07-01$81.24$63.21RVU13C
2013-04-01$81.24$63.21RVU13B
2013-01-01$81.24$63.21RVU13AR

Price 92604 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

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
RVUs for 92604PPRRVU2026_Oct_nonQPP.csv, line 11,862 (RVU26D)
Geographic factors for West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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