CPT 92612
Global XXX ActiveEndoscopy swallow (fees) vid
CPT 92612 Billing & Documentation Guide
CPT code 92612 (Endoscopy swallow (fees) vid) is classified under Audiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.24, a non-facility practice expense RVU of 4.69, and a malpractice RVU of 0.05, a total non-facility RVU of 5.98 and facility RVU of 1.62. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $207.18, though rates vary from $176.84 to $272.76 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92612, 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 92612 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 92612 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 92612
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.24 | 1.24 |
| Practice Expense RVU | 4.69 | 0.33 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 5.98 | 1.62 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92612
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 | $229.17 | $56.85 | $214.7 - $272.76 | 29 |
| Florida | $201.84 | $55.72 | $193.68 - $208.71 | 3 |
| Georgia | $192.92 | $54 | $183.14 - $202.7 | 2 |
| Illinois | $196.12 | $55.41 | $187.05 - $205.55 | 4 |
| Michigan | $190.86 | $54.12 | $186.32 - $195.4 | 2 |
| North Carolina | $188.64 | $52.77 | $188.64 - $188.64 | 1 |
| New York | $220.41 | $57.94 | $191.41 - $233.43 | 5 |
| Ohio | $186.12 | $53.16 | $186.12 - $186.12 | 1 |
| Pennsylvania | $197.02 | $54.37 | $186.8 - $207.23 | 2 |
| Texas | $197.42 | $54.05 | $185.52 - $208.72 | 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 92612
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92612 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 31575 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 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 |
| 69705 | Column 1 (primary), can be billed with modifier | No | More extensive procedure |
| 69706 | Column 1 (primary), can be billed with modifier | No | More extensive procedure |
| 76120 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 76125 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 92511 | Column 1 (primary), can be billed with modifier | No | More extensive procedure |
| 92520 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 92610 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 92612
What does CPT code 92612 mean? +
CPT code 92612 represents: Endoscopy swallow (fees) vid. It's in the Audiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92612? +
The 2026 Medicare national average non-facility payment for CPT 92612 is $207.18. Rates range from $176.84 to $272.76 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92612? +
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 92612? +
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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