CPT 92626
Global XXX ActiveEval aud funcj 1st hour
CPT 92626 Billing & Documentation Guide
CPT code 92626 (Eval aud funcj 1st hour) is classified under Audiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.4, a non-facility practice expense RVU of 1.11, and a malpractice RVU of 0.01, a total non-facility RVU of 2.52 and facility RVU of 1.79. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $86.7, though rates vary from $78.78 to $109.81 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92626, 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 92626 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 92626 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 92626
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.4 | 1.4 |
| Practice Expense RVU | 1.11 | 0.38 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 2.52 | 1.79 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92626
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 | $92.49 | $63.64 | $88.37 - $105.55 | 29 |
| Florida | $84.61 | $60.15 | $82.71 - $86.2 | 3 |
| Georgia | $82.6 | $59.34 | $80.23 - $84.97 | 2 |
| Illinois | $83.39 | $59.83 | $81.13 - $85.76 | 4 |
| Michigan | $82.04 | $59.15 | $80.99 - $83.1 | 2 |
| North Carolina | $81.57 | $58.82 | $81.57 - $81.57 | 1 |
| New York | $90.79 | $63.59 | $82.22 - $94.46 | 5 |
| Ohio | $80.95 | $58.69 | $80.95 - $80.95 | 1 |
| Pennsylvania | $83.85 | $59.97 | $81.11 - $86.6 | 2 |
| Texas | $83.83 | $59.82 | $80.81 - $86.38 | 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 92626
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92626 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 |
| 69209 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 69210 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 92621 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| G0153 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| G0161 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| G0268 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0728T | Column 2 (secondary), bundled into primary | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 92626
What does CPT code 92626 mean? +
CPT code 92626 represents: Eval aud funcj 1st hour. It's in the Audiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92626? +
The 2026 Medicare national average non-facility payment for CPT 92626 is $86.7. Rates range from $78.78 to $109.81 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92626? +
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 92626? +
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 1, 2026.
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