CPT 92603
Global XXX ActiveCochlear implt f/up exam 7/>
CPT 92603 Billing & Documentation Guide
CPT code 92603 (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 2.25, a non-facility practice expense RVU of 2.1, and a malpractice RVU of 0.01, a total non-facility RVU of 4.36 and facility RVU of 2.87. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $150.18, though rates vary from $135.58 to $187.61 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92603, 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 92603 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 92603 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 92603
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.25 | 2.25 |
| Practice Expense RVU | 2.1 | 0.61 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 4.36 | 2.87 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92603
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 | $161.02 | $102.13 | $153.48 - $184.74 | 29 |
| Florida | $146.18 | $96.25 | $142.71 - $149.01 | 3 |
| Georgia | $142.58 | $95.1 | $138.12 - $147.04 | 2 |
| Illinois | $143.83 | $95.74 | $139.71 - $148.31 | 4 |
| Michigan | $141.49 | $94.76 | $139.57 - $143.4 | 2 |
| North Carolina | $140.81 | $94.37 | $140.81 - $140.81 | 1 |
| New York | $157.42 | $101.9 | $142.02 - $163.98 | 5 |
| Ohio | $139.53 | $94.09 | $139.53 - $139.53 | 1 |
| Pennsylvania | $144.89 | $96.14 | $139.86 - $149.92 | 2 |
| Texas | $144.93 | $95.93 | $139.29 - $149.81 | 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 92603
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92603 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 | Yes | Mutually exclusive procedures |
| 0729T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 92603
What does CPT code 92603 mean? +
CPT code 92603 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 92603? +
The 2026 Medicare national average non-facility payment for CPT 92603 is $150.18. Rates range from $135.58 to $187.61 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92603? +
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 92603? +
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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