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    v1.0.30
    OpenPayerBilling CodesEvaluative and Therapeutic Otorhinolaryngologic ServicesCPT cpt-92601-cochlear-implant-analysis-programming-under-7
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    CPT 92601: Cochlear Implant Analysis and Programming, Patient <7

    Medicare pays $160 and commercial payers pay $287 on average nationally for this procedure.

    CPT code 92601 describes analysis and programming of a previously implanted cochlear device for a patient younger than 7 years, including all necessary device programming and counseling of the patient and family; service type: cochlear implant analysis and programming with counseling; typical site of service: audiology or otolaryngology clinic, outpatient specialty center, or hospital outpatient department.

    For related coverage guidance, see recent payer policy updates: Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM), Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®), Lumbar Microdiscectomy.

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    National Reimbursement Benchmarks

    Nationally, Medicare’s average allowed rate for CPT 92601 sits at $160, notably below BUCA’s mean commercial level of $286.80 — a gap of $126.80 that highlights a sizable commercial-to-Medicare differential. Blue Cross Blue Shield’s mean of $357.50 and Aetna’s lower mean of $103.80 further emphasize commercial variability, while UnitedHealth Group ($239.60) and Cigna ($234.00) sit between those extremes.

    Assessing dispersion using the interquartile spread (P75 minus P25) reveals Blue Cross Blue Shield has the widest midspread at $139 (P75 $421.40 minus P25 $282.50), followed by BUCA at $136.50 (P75 $347.20 minus P25 $210.70). The tightest spreads are Aetna at $17 (P75 $152.00 minus P25 $31.60) and UnitedHealth Group at $147 (P75 $302.90 minus P25 $156.10) — noting UnitedHealth Group’s is actually wider than BUCA’s in absolute terms, while Aetna shows the least IQR concentration.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 3-year-old child with congenital bilateral sensorineural hearing loss (H90.3) and a prior cochlear implant (Z96.21) presents for routine post-implant device management. The visit is scheduled in an outpatient otolaryngology/audiology clinic. The clinical workflow begins with a brief history and parent interview to assess sound awareness, speech milestones, device use, and any skin or device-related concerns. An audiologist or otolaryngologist performs objective checks of external processor function and battery/coil integrity, followed by diagnostic interface connection to the implant for comprehensive analysis. The provider completes programming (mapping) of the implant’s electrode array to optimize thresholds and comfort levels for speech perception, documents changes, and provides hands-on counseling and training to the family about device care, troubleshooting, and listening therapy. The encounter may include demonstration of external processor care, earmold/retention strategies, and coordination of early intervention services. Typical site of service is an outpatient clinic or ambulatory surgery center designated for cochlear implant programming and follow-up. Service type: device management and reprogramming (post-implant programming and counseling) for a patient younger than 7 years of age.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    92602

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Y00000X
    237600000X
    207YX0602X
    101YA0400X
    2279P1006X
    364SP0810X
    367A00000X
    364SL0600X

    Related ICD-10-CM Codes

    5 rows

    ICD-10-CM CodeDescription
    Z96.21Cochlear implant status
    H90.3Sensorineural hearing loss, bilateral
    H90.5Unspecified sensorineural hearing loss
    H91.90Unspecified hearing loss, unspecified ear
    H91.93Unspecified hearing loss, bilateral

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)Kaiser Permanente2027-01-01
    Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)bcbsvermont2026-11-01
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Decompressionuniverahealthcare2026-10-15
    Responsive Neurostimulation for Focal EpilepsyPremera Bluecross2026-10-14
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    High-Intensity Focused UltrasoundMass General Brigham Health Plan2026-10-01
    Vagal Nerve StimulationAmbetter Nevada2026-10-01

    Related Codes

    CPT-92602-COCHLEAR-IMPLANT-REPROGRAMMING-PEDIATRIC

    CPT 92602: Cochlear Implant Reprogramming, Patient <7 Years

    CPT-92603-COCHLEAR-IMPLANT-ANALYSIS-AND-PROGRAMMING

    CPT 92603: Cochlear Implant Programming and Patient Counseling

    CPT-92604-COCHLEAR-IMPLANT-REPROGRAMMING

    CPT 92604: Cochlear Implant Reprogramming, Age 7 and Older

    CPT-92605-AAC-DEVICE-EVALUATION-ONE-HOUR

    CPT 92605: Evaluation for Non–Speech–Generating Communication Device

    CPT-92606-ASSISTIVE-COMMUNICATION-DEVICE-TRAINING-CAREGIVER-INSTRUCTION

    CPT 92606: Therapeutic Training for Non‑Speech Generating Device

    CPT-92607-SPEECH-GENERATING-DEVICE-EVALUATION-FIRST-HOUR

    CPT 92607: Evaluation for Speech‑Generating Device, First Hour

    CPT-92608-SPEECH-GENERATING-DEVICE-ADDITIONAL-30-MIN-EVAL

    CPT 92608: Additional 30-Minute Speech‑Generating Device Evaluation

    CPT-92609-SPEECH-GENERATING-DEVICE-THERAPY-CAREGIVER-TRAINING

    CPT 92609: Therapeutic Training for Speech‑Generating Device

    CPT-92610-SPECIAL-OTORHINOLARYNGOLOGIC-PROCEDURE-SWALLOWING-EVALUATION

    CPT 92610: Special Otolaryngologic Procedure for Swallowing Evaluation

    CPT-92611-ENDOSCOPIC-CINE-VIDEO-SWALLOWING-STUDY

    CPT 92611: Videofluoroscopic Swallowing Study (Cine/Video)

    Showing 1–10 of 37

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Reprogramming of cochlear implant, patient younger than 7 years
    Alternate or related code for reprogramming sessions; often used when programming is the sole service without full diagnostic analysis.
    92603Diagnostic analysis of cochlear implant, patient age 7 years or older; with programmingRelated diagnostic analysis code for older patients; included for cross-reference to age-based coding differences.
    92604Reprogramming of cochlear implant, patient age 7 years or olderRelated reprogramming code for patients aged 7 and older; contrasts with 92601 age-based descriptor.
    92557Comprehensive audiometry threshold evaluation and speech recognitionFrequently performed before or after programming to document audiometric thresholds and speech recognition performance for mapping verification.