CPT 92511
Global 000 ActiveNasopharyngoscopy
CPT 92511 Billing & Documentation Guide
CPT code 92511 (Nasopharyngoscopy) is classified under Audiology with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.59, a non-facility practice expense RVU of 2.84, and a malpractice RVU of 0.04, a total non-facility RVU of 3.47 and facility RVU of 0.98. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $120.25, though rates vary from $101.88 to $159.38 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92511, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 92511 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 92511 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 92511
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.59 | 0.59 |
| Practice Expense RVU | 2.84 | 0.35 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 3.47 | 0.98 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92511
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $133.38 | $34.97 | $124.72 - $159.38 | 29 |
| Florida | $117.48 | $34.03 | $112.4 - $121.83 | 3 |
| Georgia | $111.83 | $32.49 | $105.91 - $117.75 | 2 |
| Illinois | $113.99 | $33.63 | $108.4 - $119.63 | 4 |
| Michigan | $110.66 | $32.57 | $107.82 - $113.5 | 2 |
| North Carolina | $109.06 | $31.47 | $109.06 - $109.06 | 1 |
| New York | $128.28 | $35.5 | $110.76 - $136.24 | 5 |
| Ohio | $107.66 | $31.73 | $107.66 - $107.66 | 1 |
| Pennsylvania | $114.23 | $32.76 | $108.05 - $120.4 | 2 |
| Texas | $114.44 | $32.57 | $107.27 - $121.29 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 92511
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92511 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0216T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
Frequently Asked Questions, CPT 92511
What does CPT code 92511 mean? +
CPT code 92511 represents: Nasopharyngoscopy. It's in the Audiology category with a global period of 000.
What is the Medicare reimbursement for CPT 92511? +
The 2026 Medicare national average non-facility payment for CPT 92511 is $120.25. Rates range from $101.88 to $159.38 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92511? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 92511? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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