CPT 92651
Global XXX ActiveAep hearing status deter i&r
CPT 92651 Billing & Documentation Guide
CPT code 92651 (Aep hearing status deter i&r) is classified under Audiology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.98, a non-facility practice expense RVU of 1.38, and a malpractice RVU of 0.04, a total non-facility RVU of 2.4 and facility RVU of 2.4. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $82.65, though rates vary from $73.02 to $103.52 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 92651, 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 92651 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 92651 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 92651
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.98 | 0.98 |
| Practice Expense RVU | 1.38 | 1.38 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 2.4 | 2.4 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 92651
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 | $89.17 | $89.17 | $84.52 - $103.52 | 29 |
| Florida | $81.58 | $81.58 | $78.81 - $84.09 | 3 |
| Georgia | $78.35 | $78.35 | $75.44 - $81.27 | 2 |
| Illinois | $79.94 | $79.94 | $76.9 - $82.67 | 4 |
| Michigan | $77.9 | $77.9 | $76.32 - $79.47 | 2 |
| North Carolina | $76.59 | $76.59 | $76.59 - $76.59 | 1 |
| New York | $87.52 | $87.52 | $77.46 - $92.11 | 5 |
| Ohio | $76.16 | $76.16 | $76.16 - $76.16 | 1 |
| Pennsylvania | $79.61 | $79.61 | $76.31 - $82.9 | 2 |
| Texas | $79.53 | $79.53 | $75.92 - $82.75 | 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 92651
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 92651 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 |
| 92653 | Column 1 (primary), can be billed with modifier | No | More extensive procedure |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0728T | Column 2 (secondary), bundled into primary | Yes | Misuse of Column Two code with Column One code |
| 0729T | Column 2 (secondary), bundled into primary | Yes | Misuse of Column Two code with Column One code |
| 92601 | Column 2 (secondary), bundled into primary | Yes | Misuse of Column Two code with Column One code |
| 92602 | Column 2 (secondary), bundled into primary | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 92651
What does CPT code 92651 mean? +
CPT code 92651 represents: Aep hearing status deter i&r. It's in the Audiology category with a global period of XXX.
What is the Medicare reimbursement for CPT 92651? +
The 2026 Medicare national average non-facility payment for CPT 92651 is $82.65. Rates range from $73.02 to $103.52 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 92651? +
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 92651? +
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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