How much does Medicare pay for CPT 92604?

Medicare allowed an average of $85.74 per service and paid $61.54 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $269.78, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92604?

Analysis and reprogramming of inner ear implant (7 years or older). It was billed 23,130 times to 13,334 Medicare beneficiaries by 483 providers in 2024.

Does 92604 pay differently in an office than a hospital?

Yes. The allowed amount averaged $86.67 in an office setting and $64.42 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 92604 most?

Audiologist, with 20,906 services from 448 clinicians. Next are Otolaryngology, Physician Assistant, Nurse Practitioner.

CPT 92604

Analysis and reprogramming of inner ear implant (7 years or older)

$85.74Medicare-allowed amount per service, averaged across 23,130 services

Providers submitted

$269.78

Asking price, not received

Medicare allowed

$85.74

The fee schedule figure

Medicare paid

$61.54

Balance is patient coinsurance

Providers submitted an average of $269.78 for this code and Medicare allowed $85.74 — 3.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $61.54 (72%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $86.67
Hospital / facility: $64.42

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 22,161 services were billed in an office setting and 969 in a facility.

Services: 23,130
Beneficiaries: 13,334
Providers billing it: 483
Total allowed: $1,983,166

What Medicare pays for CPT 92604

Across 23,130 services billed by 483 providers to 13,334 beneficiaries, Medicare allowed an average of $85.74 per service. That is 1.7 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 92604

Specialty	Services	Beneficiaries	Avg allowed	Providers
Audiologist	20,906	12,055	$85.72	448
Otolaryngology	2,129	1,212	$86.44	33
Physician Assistant	84	56	$73.35	1
Nurse Practitioner	11	11	$70.35	1

92604 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	2,547	$86.75	$63.03	44
Texas	1,862	$86.41	$61.87	35
California	1,429	$97.34	$63.70	33
Arizona	1,262	$85.53	$62.14	24
Oklahoma	1,032	$81.68	$62.93	20
New York	888	$96.90	$61.40	12
Missouri	860	$84.81	$61.32	15
Ohio	832	$77.92	$56.76	23
South Carolina	696	$83.21	$64.22	12
Georgia	655	$87.89	$60.33	13
Pennsylvania	638	$76.42	$56.58	14
Illinois	616	$88.27	$59.87	15
Virginia	614	$88.36	$64.10	13
Maryland	577	$91.49	$62.50	8
Indiana	556	$82.91	$67.43	10
Colorado	550	$88.65	$62.70	11
North Carolina	542	$79.74	$62.65	16
Minnesota	535	$77.96	$61.51	14
Michigan	463	$85.85	$61.98	12
Kentucky	453	$84.09	$60.59	11
Alabama	449	$81.13	$62.05	8
Tennessee	440	$80.32	$63.18	9
Nebraska	384	$81.64	$61.65	8
Oregon	375	$86.95	$61.90	12
Washington	348	$90.40	$65.76	10
Mississippi	317	$78.36	$65.14	4
Iowa	304	$81.27	$63.63	6
Montana	274	$86.71	$62.10	6
Idaho	250	$70.24	$51.55	7
Utah	239	$84.35	$63.19	6
Massachusetts	220	$81.43	$53.94	6
Nevada	200	$86.77	$63.78	6
New Hampshire	178	$76.30	$54.00	3
Arkansas	168	$79.85	$64.43	4
Wisconsin	167	$80.24	$57.94	4
Kansas	160	$86.33	$63.42	3
Connecticut	150	$93.64	$63.01	4
South Dakota	143	$86.92	$63.59	2
New Mexico	134	$81.69	$57.99	3
Alaska	133	$105.98	$65.33	3
New Jersey	113	$97.57	$63.57	2
District of Columbia	91	$101.54	$64.83	3
Maine	91	$74.95	$55.52	3
West Virginia	89	$80.29	$63.07	2
North Dakota	47	$87.40	$64.02	2
Wyoming	39	$87.05	$64.20	1
Hawaii	20	$94.08	$64.18	1

Related codes

92610Evaluation of swallowing function$85.94
92653Evaluation of brain response to sound for diagnosis of nervous system$83.07
92626Evaluation of hearing function related to surgically implanted hearing$83.86
92611Evaluation of swallowing function image$91.51
92609Therapy service for use of speech-generating device$104.52
92625Evaluation of hearing ringing in ear$67.08
92612Evaluation and recording of swallowing$195.12
92652Evaluation of brain response to sound for determination of hearing thr$112.41
92613Evaluation, recording, and interpretation of swallowing using an endos$37.04
92627Evaluation of hearing function related to surgically implanted hearing$20.15
92616Evaluation and recording of swallowing and voice box sensory function$198.20
92620Evaluation of hearing function brain responses$88.68

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.