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See a sample rate comparisonCPT 92604 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.
Program Or Adjust Ear Implant, Programming Or Adjustment Of Cochlear Implant (Electronic Device Implanted In The Inner Ear To Create Sound Sensations. Used As Treatment For Deafness).
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Otorhinolaryngologic Services and Procedures |
| Common Place of Service | 11 - Office 19 - Off Campus Outpatient Hospital |
| Common Modifiers | PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | $87.51 national non-facility rate (2026) · View Medicare rates for 92604 |
| Medicaid Fee Schedule | $71.265 median of the 8 states in the free preview · View Medicaid rates for 92604 |
National average reimbursement for CPT 92604 by major payers:
$109.73
$111.91
$117.57
$139.49
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CPT 92604
5 of 25 sample ratesHigher to lower in this preview
Afsaneh Talai
$235.53Published rateAngela Green
$183.75Published rateKaren Severson
Loyola University Medical Center
$176.10Published rateVinod Alluri
Loyola University Medical Center
$148.57Published rateChristopher Raio
St Joseph Hospital
$86.33Published rate
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See a sample payer proposalCPT 92604 vs. Other Special Otorhinolaryngologic Services and Procedures Codes
The CPT 92604 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 92604 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 |
|---|---|---|
| 92601-CPT | Moderate | Program Or Adjust Ear Implant, Programming Or Adjustment Of Cochlear Implant (Electronic Device Implanted In The Inner Ear To Create Sound Sensations. Used As Treatment For Deafness). |
| 92602-CPT | Low | Program Or Adjust Ear Implant, Programming Or Adjustment Of Cochlear Implant (Electronic Device Implanted In The Inner Ear To Create Sound Sensations. Used As Treatment For Deafness). |
| 92603-CPT | Low | Program Or Adjust Ear Implant, Programming Or Adjustment Of Cochlear Implant (Electronic Device Implanted In The Inner Ear To Create Sound Sensations. Used As Treatment For Deafness). |
| 92604-CPT | Low | Program Or Adjust Ear Implant, Programming Or Adjustment Of Cochlear Implant (Electronic Device Implanted In The Inner Ear To Create Sound Sensations. Used As Treatment For Deafness). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92604. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92604 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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