CPT 92601
Global XXX ActiveCochlear implt f/up exam <7
CPT 92601 Billing & Documentation Guide
CPT code 92601 (Cochlear implt f/up exam <7) is classified under Audiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.3, a non-facility practice expense RVU of 2.31, and a malpractice RVU of 0.01, a total non-facility RVU of 4.62 and facility RVU of 2.94. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $159.2, though rates vary from $143.27 to $197.59 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92601, 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 92601 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 92601 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 92601
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.3 | 2.3 |
| Practice Expense RVU | 2.31 | 0.63 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 4.62 | 2.94 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92601
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 | $171.05 | $104.65 | $162.87 - $196.71 | 29 |
| Florida | $154.89 | $98.58 | $151.09 - $157.99 | 3 |
| Georgia | $150.94 | $97.41 | $146.04 - $155.84 | 2 |
| Illinois | $152.28 | $98.06 | $147.79 - $157.19 | 4 |
| Michigan | $149.74 | $97.05 | $147.64 - $151.84 | 2 |
| North Carolina | $149.02 | $96.67 | $149.02 - $149.02 | 1 |
| New York | $166.99 | $104.39 | $150.36 - $174.1 | 5 |
| Ohio | $147.6 | $96.37 | $147.6 - $147.6 | 1 |
| Pennsylvania | $153.45 | $98.48 | $147.97 - $158.92 | 2 |
| Texas | $153.51 | $98.27 | $147.34 - $158.9 | 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 92601
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92601 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0208T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0209T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0210T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0211T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0212T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0485T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0486T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0728T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0729T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 92601
What does CPT code 92601 mean? +
CPT code 92601 represents: Cochlear implt f/up exam <7. It's in the Audiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92601? +
The 2026 Medicare national average non-facility payment for CPT 92601 is $159.2. Rates range from $143.27 to $197.59 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92601? +
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 92601? +
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 June 2, 2026.
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