CPT 92538
Global XXX ActiveCaloric vstblr test w/rec
CPT 92538 Billing & Documentation Guide
CPT code 92538 (Caloric vstblr test w/rec) is classified under Audiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.29, a non-facility practice expense RVU of 0.34, and a malpractice RVU of 0.02, a total non-facility RVU of 0.65 and facility RVU of 0.65. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $22.31, though rates vary from $19.79 to $27.49 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92538, 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 92538 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 92538 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 92538
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.29 | 0.29 |
| Practice Expense RVU | 0.34 | 0.34 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 0.65 | 0.65 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92538
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 | $23.84 | $23.84 | $22.66 - $27.49 | 29 |
| Florida | $22.38 | $22.38 | $21.55 - $23.2 | 3 |
| Georgia | $21.34 | $21.34 | $20.61 - $22.06 | 2 |
| Illinois | $21.97 | $21.97 | $21.1 - $22.7 | 4 |
| Michigan | $21.29 | $21.29 | $20.81 - $21.77 | 2 |
| North Carolina | $20.71 | $20.71 | $20.71 - $20.71 | 1 |
| New York | $23.72 | $23.72 | $20.94 - $25.05 | 5 |
| Ohio | $20.73 | $20.73 | $20.73 - $20.73 | 1 |
| Pennsylvania | $21.61 | $21.61 | $20.74 - $22.48 | 2 |
| Texas | $21.54 | $21.54 | $20.64 - $22.31 | 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 92538
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92538 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 69209 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 69210 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 99446 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99447 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99448 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99449 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99451 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 92538
What does CPT code 92538 mean? +
CPT code 92538 represents: Caloric vstblr test w/rec. It's in the Audiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92538? +
The 2026 Medicare national average non-facility payment for CPT 92538 is $22.31. Rates range from $19.79 to $27.49 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92538? +
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 92538? +
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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