How much does Medicare pay for CPT 92616?

Medicare allowed an average of $198.20 per service and paid $155.91 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $543.40, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92616?

Evaluation and recording of swallowing and voice box sensory function using an endoscope. It was billed 1,594 times to 1,264 Medicare beneficiaries by 20 providers in 2024.

Does 92616 pay differently in an office than a hospital?

Yes. The allowed amount averaged $235.24 in an office setting and $109.62 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 92616 most?

Otolaryngology, with 927 services from 14 clinicians. Next are Speech Language Pathologist.

CPT 92616

Evaluation and recording of swallowing and voice box sensory function using an endoscope

$198.20Medicare-allowed amount per service, averaged across 1,594 services

Providers submitted

$543.40

Asking price, not received

Medicare allowed

$198.20

The fee schedule figure

Medicare paid

$155.91

Balance is patient coinsurance

Providers submitted an average of $543.40 for this code and Medicare allowed $198.20 — 2.7× 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 $155.91 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $235.24
Hospital / facility: $109.62

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. 1,124 services were billed in an office setting and 470 in a facility.

Services: 1,594
Beneficiaries: 1,264
Providers billing it: 20
Total allowed: $315,931

What Medicare pays for CPT 92616

Across 1,594 services billed by 20 providers to 1,264 beneficiaries, Medicare allowed an average of $198.20 per service. That is 1.3 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 92616

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	927	784	$176.48	14
Speech Language Pathologist	667	480	$228.38	6

92616 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
New York	866	$175.59	$122.88	10
Texas	696	$228.03	$174.43	8
Mississippi	17	$90.91	$76.77	1
California	15	$241.07	$181.82	1

Related codes

92610Evaluation of swallowing function$85.94
92604Analysis and reprogramming of inner ear implant (7 years or older)$85.74
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
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.