CPT 92549
Global XXX ActiveCdp-sot 6 cond w/i&r mct&adt
CPT 92549 Billing & Documentation Guide
CPT code 92549 (Cdp-sot 6 cond w/i&r mct&adt) is classified under Audiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.85, a non-facility practice expense RVU of 1, and a malpractice RVU of 0.02, a total non-facility RVU of 1.87 and facility RVU of 1.87. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $64.4, though rates vary from $57.43 to $80.04 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92549, 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 92549 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 92549 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 92549
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.85 | 0.85 |
| Practice Expense RVU | 1 | 1 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 1.87 | 1.87 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92549
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 | $69.29 | $69.29 | $65.84 - $80.04 | 29 |
| Florida | $63.2 | $63.2 | $61.33 - $64.85 | 3 |
| Georgia | $61.1 | $61.1 | $58.98 - $63.21 | 2 |
| Illinois | $62.04 | $62.04 | $59.93 - $64.08 | 4 |
| Michigan | $60.7 | $60.7 | $59.64 - $61.75 | 2 |
| North Carolina | $59.98 | $59.98 | $59.98 - $59.98 | 1 |
| New York | $67.91 | $67.91 | $60.59 - $71.16 | 5 |
| Ohio | $59.56 | $59.56 | $59.56 - $59.56 | 1 |
| Pennsylvania | $62.08 | $62.08 | $59.68 - $64.47 | 2 |
| Texas | $62.05 | $62.05 | $59.41 - $64.38 | 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 92549
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92549 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 |
| 92270 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 92548 | Column 1 (primary), can be billed with modifier | No | HCPCS/CPT procedure code definition |
| 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 92549
What does CPT code 92549 mean? +
CPT code 92549 represents: Cdp-sot 6 cond w/i&r mct&adt. It's in the Audiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92549? +
The 2026 Medicare national average non-facility payment for CPT 92549 is $64.4. Rates range from $57.43 to $80.04 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92549? +
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 92549? +
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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