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See a sample rate comparisonCPT 92526 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Treatmn Of Swallowing Dysfunc &/Or Oral Funct For Feed, Treatment Of Swallowing Dysfunction And/Or Oral Function For Feeding
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Otorhinolaryngologic Services and Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | GN - Services delivered under an outpatient speech language pathology plan of care KX - Requirements specified in the medical policy have been met |
| Complexity Level | Low |
| Medicare Fee Schedule | $84.17 national non-facility rate (2026) · View Medicare rates for 92526 |
| Medicaid Fee Schedule | $71.14 median of the 7 states in the free preview · View Medicaid rates for 92526 |
National average reimbursement for CPT 92526 by major payers:
$113.46
$110.22
$107.90
$135.24
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CPT 92526
5 of 25 sample ratesHigher to lower in this preview
James Mackenzie
Lurie Childrens Medical Group LLC
$231.47Published rateMatthew Atienza
Advocate Health And Hospitals Corporation
$177.83Published rateJyoti Shah
Edward Health Ventures
$133.74Published ratePatricia Mumby
Loyola University Medical Center
$120.54Published rateMichael Bednarz
Veterans Assistance Commission C
$71.01Published rate
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See a sample payer proposalCPT 92526 vs. Other Special Otorhinolaryngologic Services and Procedures Codes
The CPT 92526 code is part of the Medicine Services and Procedures services used for Special Otorhinolaryngologic Services and Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 92526 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 92524-CPT | Low | Speech Analysis, An Observation And Analysis Of A Persons Speech Patterns And Vocal Behavior To Determine Speech Therapy Needs. |
| 92526-CPT | Low | Treatmn Of Swallowing Dysfunc &/Or Oral Funct For Feed, Treatment Of Swallowing Dysfunction And/Or Oral Function For Feeding |
| 92531-CPT | Low | Test Or Eye Exam For Nystagmus, Observation Of The Eyes Or Other Testing For Nystagmus (Uncontrolled Rapid Movement Of The Eyeballs). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92526. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92526 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
CPT (Current Procedural Terminology) codes are a standardized set of five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for understanding medical costs because they are universally recognized by insurers and healthcare providers for billing and reimbursement purposes. Knowing the CPT code for a service allows you to research its cost more effectively and compare prices across different providers or locations.
To find out the cost of a specific medical procedure or service, you should first ask your healthcare provider for the relevant CPT code. Once you have the CPT code, you can use online tools to research average prices. For specific fee schedule lookups based on a CPT code and your specific location, we recommend utilizing a specialized tool like Payerprice. They offer a fee schedule lookup tool that can help you understand potential costs. It's also advisable to contact your insurance company to understand your out-of-pocket expenses, deductibles, and co-pays.
Fee schedules, which outline the maximum reimbursement amounts for various medical services, are often complex and can vary significantly by payer and geographic location. For individuals seeking to understand specific fee schedules based on CPT codes and their location, we highly recommend utilizing a specialized tool such as Payerprice. Payerprice provides a fee schedule lookup tool that allows you to search with a CPT code and your specific location to find relevant pricing information.
An in-network provider has a contractual agreement with your insurance company to provide services at pre-negotiated rates. This generally results in lower out-of-pocket costs for you, including lower co-pays, deductibles, and co-insurance. An out-of-network provider does not have such a contract, meaning your insurance may cover a smaller percentage of the cost, or you may be responsible for a larger portion of the bill, potentially including 'balance billing' where the provider charges you the difference between their fee and what your insurance pays. Always verify a provider's network status before receiving services.
To best prepare for unexpected medical bills, it's essential to thoroughly understand your insurance policy's coverage, including your deductible, co-pays, and out-of-pocket maximums. For planned procedures, always ask for the CPT code beforehand and research potential costs using tools like Payerprice to get an estimate based on your specific location. Additionally, maintaining an emergency fund can significantly help cover unforeseen healthcare expenses. Don't hesitate to negotiate prices with providers or inquire about payment plans if you receive a substantial bill.