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.
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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.