CPT 92613
Global XXX ActiveEndoscopy swallow (fees) i&r
CPT 92613 Billing & Documentation Guide
CPT code 92613 (Endoscopy swallow (fees) i&r) is classified under Audiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.69, a non-facility practice expense RVU of 0.34, and a malpractice RVU of 0.04, a total non-facility RVU of 1.07 and facility RVU of 0.9. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $36.51, though rates vary from $33.49 to $47.4 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92613, 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 92613 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 92613 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 92613
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.69 | 0.69 |
| Practice Expense RVU | 0.34 | 0.17 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 1.07 | 0.9 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92613
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 | $38.03 | $31.32 | $36.6 - $42.67 | 29 |
| Florida | $37.04 | $31.34 | $35.91 - $38.25 | 3 |
| Georgia | $35.52 | $30.1 | $34.77 - $36.26 | 2 |
| Illinois | $36.66 | $31.17 | $35.5 - $37.69 | 4 |
| Michigan | $35.59 | $30.26 | $34.92 - $36.26 | 2 |
| North Carolina | $34.5 | $29.2 | $34.5 - $34.5 | 1 |
| New York | $38.63 | $32.29 | $34.77 - $40.51 | 5 |
| Ohio | $34.76 | $29.58 | $34.76 - $34.76 | 1 |
| Pennsylvania | $35.81 | $30.24 | $34.73 - $36.88 | 2 |
| Texas | $35.6 | $30.01 | $34.62 - $36.35 | 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 92613
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92613 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 |
| 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 |
| 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 |
| 92611 | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 92615 | Column 2 (secondary), bundled into primary | No | Misuse of Column Two code with Column One code |
| 92617 | Column 2 (secondary), bundled into primary | No | HCPCS/CPT procedure code definition |
Frequently Asked Questions, CPT 92613
What does CPT code 92613 mean? +
CPT code 92613 represents: Endoscopy swallow (fees) i&r. It's in the Audiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92613? +
The 2026 Medicare national average non-facility payment for CPT 92613 is $36.51. Rates range from $33.49 to $47.4 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92613? +
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 92613? +
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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