Billing code 92604: Cochlear implant programmingMedicare rate & RVUs
An audiologist adjusts a cochlear implant user's processor settings for patients age 7 or older when programming changes are performed.
Medicare pays $87.51 for 92604 nationally in the office and $53.44 in a hospital or facility. Local office rates run $80.94–$112.03.
Medicare rate · 92604
Cochlear implant programming
Swap in your local Medicare rate.
- Work RVUs
- 1.25
- Total RVUs
- 2.62
- Global days
- XXX
National rate · 2026
$87.51
Office setting, before claim adjustments.
See every locality for 92604 → · 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 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.
Where 92604 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
$80.94 to $112.03
109 of 109 payment localities
92604 rates by state
Office rate range in each state. Select a state to see its payment localities.
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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
Swap in your local Medicare rate.
Work 1.25Practice expense 1.36Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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
| 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
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.
92604 compared with similar codes
Compare codes
92604 vs 92603 vs 92602 vs 92601: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 92603Implant analysis
- Use 92604 when processor programming is performed for a patient age 7 or older; use 92603 for diagnostic analysis of the implant in that age group.
- 92602Implant reprogramming
- Both describe cochlear implant reprogramming, but 92602 is for patients younger than 7 and 92604 is for patients age 7 or older.
- 92601Cochlear implant
- 92601 is diagnostic analysis for a patient younger than 7. It is not the reprogramming code for that age group; 92602 describes reprogramming.
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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