Billing code 92626: Auditory evaluationMedicare rate & RVUs in Ohio
Evaluates auditory function for a patient being considered for a surgically implanted hearing device or assessed after implantation during the initial hour.
Medicare pays $80.95 for 92626 in the office in Ohio (Ohio). Which amount applies depends on the service address.
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 9 sections
What 92626 covers
An audiologist evaluates auditory function when a patient is being considered for a surgically implanted hearing device or is being assessed after implantation. The assessment may use structured measures of sound detection and speech understanding to characterize functional hearing and device benefit. Common settings include audiology clinics and hospital-based audiology departments, such as during a cochlear implant candidacy workup or after implantation.
Report 92626 for the initial hour devoted to this device-focused evaluation. Document the clinical purpose, tests performed, findings, and time. Use 92627 for each additional 15 minutes when the service extends beyond the initial hour. Choose this code for evaluation related to candidacy for or status after a surgically implanted auditory device, rather than a routine hearing assessment or hearing-aid candidacy evaluation. CMS pricing treats 92626 as bilateral, so modifier 50 does not increase payment when both ears are assessed.
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.
92626 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $80.95 | $58.69 |
How the 92626 rate is calculated
Each of 92626’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 · 92626
RVUs × geographic indexes × conversion factor
Work1.40
1.40 RVUs× 1.000 GPCI
Practice expense1.11
1.11 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
2.5200
Conversion factor
$33.4009
Medicare rate
$84.17
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 92626
The CMS indicators that decide how 92626 is paid alongside other services.
CMS payment indicators · 92626
Auditory evaluation
| 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 | 0 | Physician service: no professional/technical split. |
92626 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 92627Auditory evaluation
- 92626 covers the initial hour of the implanted-device auditory evaluation. Use 92627 for each additional 15 minutes.
- 92620Implant auditory evaluation
- 92620 addresses auditory-function evaluation for hearing assessment generally; 92626 is selected when the evaluation concerns candidacy for or status after a surgically implanted auditory device.
- 92628Eval hearing aid cand 1st 30
- 92628 evaluates candidacy for hearing aids. Use 92626 when the evaluation concerns a surgically implanted auditory device.
92626 billing questions
When should I choose 92626 instead of 92620?
Use 92626 when the auditory evaluation concerns candidacy for a surgically implanted hearing device or postoperative status. Code 92620 is for auditory-function evaluation not specifically tied to that implanted-device purpose.
How is additional time reported?
Code 92626 represents the initial hour. Report 92627 for each additional 15 minutes when the evaluation continues beyond that hour, and document the time spent.
Should I append modifier 50 when both ears are evaluated?
No. CMS pricing already treats 92626 as bilateral, and modifier 50 does not increase payment.
What documentation supports 92626?
Document whether the evaluation addresses implanted-device candidacy or postoperative status, the auditory measures performed, the findings, and the time devoted to the service.
Is hearing-aid candidacy evaluated with 92626?
No. For an evaluation of hearing-aid candidacy, consider the hearing-aid candidacy service code instead; 92626 is specific to a surgically implanted auditory device.
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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