How much does Medicare pay for CPT 92626?

Medicare allowed an average of $83.86 per service and paid $61.07 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $261.10, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 92626?

Evaluation of hearing function related to surgically implanted hearing device, first hour. It was billed 16,921 times to 12,754 Medicare beneficiaries by 440 providers in 2024.

Does 92626 pay differently in an office than a hospital?

Yes. The allowed amount averaged $84.34 in an office setting and $72.08 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 92626 most?

Audiologist, with 15,247 services from 406 clinicians. Next are Otolaryngology, Physician Assistant, Allergy/ Immunology.

CPT 92626

Evaluation of hearing function related to surgically implanted hearing device, first hour

$83.86Medicare-allowed amount per service, averaged across 16,921 services

Providers submitted

$261.10

Asking price, not received

Medicare allowed

$83.86

The fee schedule figure

Medicare paid

$61.07

Balance is patient coinsurance

Providers submitted an average of $261.10 for this code and Medicare allowed $83.86 — 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 $61.07 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $84.34
Hospital / facility: $72.08

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. 16,253 services were billed in an office setting and 668 in a facility.

Services: 16,921
Beneficiaries: 12,754
Providers billing it: 440
Total allowed: $1,418,995

What Medicare pays for CPT 92626

Across 16,921 services billed by 440 providers to 12,754 beneficiaries, Medicare allowed an average of $83.86 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 92626

Specialty	Services	Beneficiaries	Avg allowed	Providers
Audiologist	15,247	11,598	$83.90	406
Otolaryngology	1,517	1,011	$84.18	28
Physician Assistant	52	52	$68.63	2
Allergy/ Immunology	48	47	$81.51	1
Speech Language Pathologist	44	33	$82.80	2
Nurse Practitioner	13	13	$68.25	1

92626 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
California	2,064	$90.19	$62.17	33
Texas	1,230	$84.39	$62.26	26
Florida	1,149	$83.88	$62.25	32
New York	994	$91.08	$62.09	17
Arizona	812	$82.62	$60.85	22
Missouri	770	$81.01	$59.56	20
South Carolina	684	$80.75	$61.82	11
Oklahoma	669	$79.38	$59.61	17
Illinois	579	$81.57	$58.70	16
North Carolina	556	$81.62	$60.98	16
Wisconsin	532	$78.42	$59.37	7
Georgia	500	$85.90	$62.57	13
Minnesota	444	$84.66	$57.91	15
Washington	422	$88.63	$61.50	14
Tennessee	393	$79.91	$63.23	10
Alabama	378	$77.78	$61.01	5
Kansas	372	$79.12	$60.66	8
Pennsylvania	346	$80.13	$57.75	12
Maryland	343	$87.68	$60.38	8
Ohio	297	$73.36	$54.65	12
Kentucky	294	$81.03	$59.81	12
Michigan	251	$80.82	$60.36	11
Indiana	249	$80.79	$63.60	8
Colorado	244	$86.51	$62.86	9
Virginia	241	$81.04	$61.53	9
Nebraska	195	$80.21	$60.87	9
New Jersey	176	$92.65	$60.47	6
Massachusetts	156	$86.61	$61.26	4
Utah	153	$81.82	$59.30	5
Montana	135	$83.19	$61.00	5
Oregon	134	$85.62	$59.25	6
Iowa	131	$80.22	$63.39	5
New Mexico	127	$79.16	$57.96	3
New Hampshire	103	$79.80	$55.15	4
Delaware	100	$82.98	$57.25	3
Alaska	89	$103.90	$58.64	3
Mississippi	76	$72.83	$62.36	1
South Dakota	72	$81.12	$61.44	2
District of Columbia	68	$97.53	$62.25	3
Idaho	64	$75.45	$56.64	3
Connecticut	63	$89.19	$65.39	3
North Dakota	46	$77.20	$55.82	3
Nevada	36	$84.18	$63.52	2
Hawaii	33	$89.34	$62.00	1
Maine	31	$80.73	$58.02	1
Arkansas	29	$78.67	$60.00	1
Rhode Island	28	$83.66	$67.81	1
Louisiana	27	$83.11	$66.89	1
Wyoming	24	$83.68	$62.57	1
West Virginia	12	$79.68	$62.01	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
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.