Billing code 92603: Implant analysisMedicare rate & RVUs
Follow-up diagnostic analysis and programming of a cochlear implant in a patient aged seven or older, including assessment of device function and auditory response.
Medicare pays $145.63 for 92603 nationally in the office and $95.86 in a hospital or facility. Local office rates run $135.58–$187.61.
Medicare rate · 92603
Implant analysis
- Work RVUs
- 2.25
- Total RVUs
- 4.36
- Global days
- XXX
National rate · 2026
$145.63
Office setting, before claim adjustments.
See every locality for 92603 →Billed by an NP, PA or therapist? →
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 10 sections
What 92603 covers
An audiologist typically performs this follow-up analysis in an audiology clinic or hospital setting for a cochlear implant user aged seven or older. The visit assesses the implant system and the patient’s response, and may include checking or adjusting processor settings as part of the diagnostic analysis. It applies to adults and children who have reached age seven.
Select this code for the age-seven-or-older diagnostic analysis with programming, rather than a subsequent reprogramming service. The record should support the patient’s age, cochlear implant status, device and auditory findings, work performed, and any programming changes. CMS classifies the service as therapy: the professional component modifier does not apply, so do not append modifier 26.
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 92603 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$135.58 to $187.61
109 of 109 payment localities
92603 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.
$135.58
$187.61
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 | $187.61 | 1 |
| AL | $136.72 | 1 |
| AR | $135.58 | 1 |
| AZ | $143.41 | 1 |
| CA | $153.48–$184.74 | 29 |
| CO | $150.95 | 1 |
| CT | $152.60 | 1 |
| DC | $162.21 | 1 |
| DE | $145.13 | 1 |
| FL | $142.71–$149.01 | 3 |
| GA | $138.12–$147.04 | 2 |
| GU | $155.10 | 1 |
| HI | $155.10 | 1 |
| IA | $139.46 | 1 |
| ID | $139.84 | 1 |
| IL | $139.71–$148.31 | 4 |
| IN | $140.34 | 1 |
| KS | $138.73 | 1 |
| KY | $137.81 | 1 |
| LA | $137.55–$141.53 | 2 |
| MA | $150.48–$162.28 | 2 |
| MD | $147.19–$162.21 | 3 |
| ME | $139.89–$144.87 | 2 |
| MI | $139.57–$143.40 | 2 |
| MN | $147.43 | 1 |
| MO | $135.94–$142.26 | 3 |
| MS | $135.79 | 1 |
| MT | $145.63 | 1 |
| NC | $140.81 | 1 |
| ND | $145.43 | 1 |
| NE | $140.02 | 1 |
| NH | $148.46 | 1 |
| NJ | $155.12–$161.61 | 2 |
| NM | $139.87 | 1 |
| NV | $145.64 | 1 |
| NY | $142.02–$163.98 | 5 |
| OH | $139.53 | 1 |
| OK | $138.05 | 1 |
| OR | $145.25–$154.53 | 2 |
| PA | $139.86–$149.92 | 2 |
| PR | $146.39 | 1 |
| RI | $149.33 | 1 |
| SC | $140.25 | 1 |
| SD | $145.41 | 1 |
| TN | $139.09 | 1 |
| TX | $139.29–$149.81 | 8 |
| UT | $141.39 | 1 |
| VA | $144.34–$162.21 | 2 |
| VI | $146.39 | 1 |
| VT | $144.76 | 1 |
| WA | $150.24–$165.25 | 2 |
| WI | $142.45 | 1 |
| WV | $136.58 | 1 |
| WY | $145.54 | 1 |
How the 92603 rate is calculated
Each of 92603’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 · 92603
RVUs × geographic indexes × conversion factor
Work2.25
2.25 RVUs× 1.000 GPCI
Practice expense2.10
2.10 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
4.3600
Conversion factor
$33.4009
Medicare rate
$145.63
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92603
The CMS indicators that decide how 92603 is paid alongside other services.
CMS payment indicators · 92603
Implant analysis
| 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
92603 without CQ · national office
$145.63
Implant analysis
92603-CQ · Allowed amount unchanged
$145.63
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.
92603 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 92604Cochlear implant programming
- Use 92603 for diagnostic analysis with programming in a patient aged seven or older; 92604 is for subsequent reprogramming.
- 92601Cochlear implant
- Both represent diagnostic analysis with programming, but 92601 is for patients younger than seven; 92603 is for patients aged seven or older.
- 92602Implant reprogramming
- 92602 is subsequent reprogramming for a patient younger than seven. For a patient aged seven or older, subsequent reprogramming is reported with 92604.
92603 billing questions
How does this differ from 92604?
92603 represents diagnostic analysis with programming for a patient aged seven or older. Use 92604 for subsequent reprogramming.
Which code applies to a patient younger than seven?
Use 92601 for diagnostic analysis with programming in a patient younger than seven. Code 92602 represents subsequent reprogramming for that age group.
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 92603?
Document the patient’s age and implant status, the diagnostic assessment of the device and auditory response, and any programming performed.
Is 92603 the code for every cochlear implant follow-up?
No. The patient must be at least seven, and the service must be diagnostic analysis with programming rather than subsequent reprogramming.
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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