$96.50
Use 92601 for diagnostic analysis with programming in a child younger than 7; use 92602 for subsequent reprogramming in that age group.
On this page
CMS RVU26D · Effective 2026-10-01
92601 Cochlear implant Medicare reimbursement rates in Vermont
Report cochlear implant diagnostic analysis with programming for a child younger than 7 when the audiologist evaluates implant function and adjusts processor settings. Compare 92601 office and facility rates across CMS payment localities in Vermont.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 92601 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$153.38
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$97.82
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Audiology
About 92601: Cochlear implant analysis with programming
Report cochlear implant diagnostic analysis with programming for a child younger than 7 when the audiologist evaluates implant function and adjusts processor settings.
An audiologist uses this service to evaluate a cochlear implant and program the sound processor for a child younger than 7. The visit may include checking device function, assessing the child’s auditory responses, and adjusting the processor program, or map, based on the evaluation. It is used for pediatric cochlear implant management when diagnostic analysis and programming are performed, rather than for a programming-only visit.
Choose the code based on the patient’s age and the service performed: 92601 is for diagnostic analysis with programming under age 7; 92602 is for subsequent reprogramming in that age group. The record should support the diagnostic work and programming performed, including relevant findings and adjustments. CMS classifies this as a therapy service, so the professional component modifier 26 is not used.
CMS billing rules for 92601
- Professional and technical components
- Therapy service: the professional component modifier does not apply.
Where the value comes from
- Work RVU2.30 · 50%
- Practice expense (office) RVU2.31 · 50%
- Malpractice RVU0.01 · 0%
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.
92601 compared with similar codes
Office rates for Vermont, from the same CMS release.
$144.76
The service is diagnostic analysis with programming in both codes. The patient is younger than 7 for 92601 and age 7 or older for 92603.
$86.89
92604 describes subsequent reprogramming for a patient age 7 or older; 92601 is diagnostic analysis with programming for a child younger than 7.
Compare 92601 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Vermont →
Office / nonfacility
$153.38
Facility
$97.82
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 92601 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
11,859
- Code
- 92601
- Physician work
- 2.30
- Practice expense
- 2.31
- Malpractice
- 0.01
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.30 | × 1.000 | 2.3000 |
| Practice expense | 2.31 | × 0.990 | 2.2869 |
| Malpractice | 0.01 | × 0.506 | 0.0051 |
| Total RVUs | 4.5920 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$153.38
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.3 | 1 |
| Practice expense | 2.31 | 0.99 |
| Malpractice | 0.01 | 0.506 |
(2.3 × 1 + 2.31 × 0.99 + 0.01 × 0.506) × $33.4009 = $153.38
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.3 | 1 |
| Practice expense | 0.63 | 0.99 |
| Malpractice | 0.01 | 0.506 |
(2.3 × 1 + 0.63 × 0.99 + 0.01 × 0.506) × $33.4009 = $97.82
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
92601 billing questions
When should 92601 be selected instead of 92602?
Use 92601 when the encounter includes diagnostic analysis of the cochlear implant with programming for a child younger than 7. Use 92602 for subsequent reprogramming without that diagnostic analysis service.
How does 92601 differ from 92603?
Both describe diagnostic analysis with programming, but 92601 is for a patient younger than 7 and 92603 is for a patient age 7 or older.
Can modifier 26 be appended to 92601?
No. CMS classifies 92601 as a therapy service, for which the professional component modifier does not apply.
What documentation supports reporting 92601?
Document the cochlear implant assessment, relevant device or auditory findings, and the programming performed. The record should support diagnostic analysis, not programming alone.
Is 92601 a time-based code?
The code is distinguished by the diagnostic analysis and programming service and the patient’s age, not by a time increment in its descriptor.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
11,85692588,TC,Evoked auditory tst complete,A,,0.00,0.14,,0.14,NA,0.01,0.15,0.15,1,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
11,85792596,,Ear protector evaluation,A,,0.00,2.33,,2.33,NA,0.01,2.34,2.34,3,XXX,0.00,0.00,0.00,0,2,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,85892597,,Oral speech device eval,A,,1.23,0.88,,0.88,NA,0.02,2.13,2.13,7,XXX,0.00,0.00,0.00,5,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,85992601,,Cochlear implt f/up exam <7,A,,2.30,2.31,,0.63,,0.01,4.62,2.94,7,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
11,86092602,,Reprogram cochlear implt <7,A,,1.30,1.60,,0.36,,0.01,2.91,1.67,7,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
11,86192603,,Cochlear implt f/up exam 7/>,A,,2.25,2.10,,0.61,,0.01,4.36,2.87,7,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
11,86292604,,Reprogram cochlear implt 7/>,A,,1.25,1.36,,0.34,,0.01,2.62,1.60,7,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817