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    OpenPayerBilling CodesEvaluative and Therapeutic Otorhinolaryngologic ServicesCPT cpt-92610-special-otorhinolaryngologic-procedure-swallowing-evaluation
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    CPT 92610: Special Otolaryngologic Procedure for Swallowing Evaluation

    Medicare pays $88 and commercial payers pay $138 on average nationally for this procedure.

    CPT code 92610 describes a special otorhinolaryngologic diagnostic/treatment procedure for evaluation of swallowing function and other ear, nose, and throat procedures that are not part of a comprehensive ENT evaluation; typical service type is a specialized diagnostic/treatment procedure and the usual site of service is an outpatient otolaryngology or speech-language pathology clinic or rehabilitation center.

    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

    Commercial averages sit well above Medicare: BUCA’s mean commercial rate is $138.20 versus Medicare’s mean of $87.90, a gap of $50.30 that highlights materially higher reimbursement in commercial panels compared with the Medicare baseline. Blue Cross Blue Shield and UnitedHealth Group have notably higher mean rates ($158.10 and $134.40 respectively), while Aetna and Cigna fall between Medicare and the top commercial payers.

    Dispersion measured as the interquartile range (P75–P25) varies by payer. Blue Cross Blue Shield shows the widest IQR at $75.90, followed by UnitedHealth Group at $79.40 and BUCA at $69.30; Cigna’s IQR is $69.40. Aetna has the tightest IQR at $58.10, indicating relatively less mid-distribution spread among its rates.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with progressive oropharyngeal dysphagia presents to a multidisciplinary dysphagia clinic after recurrent aspiration pneumonia. He reports difficulty initiating a swallow and frequent coughing with thin liquids. A speech-language pathologist (SLP) performs a clinical swallowing evaluation and documents signs of oropharyngeal phase dysfunction. The otorhinolaryngology team schedules a specialized diagnostic swallowing procedure billed with 92610 to perform targeted diagnostic/treatment maneuvers that are not part of a routine otolaryngologic office visit. Typical workflow: the patient is registered at an outpatient Hearing and Speech Clinic/Center or ENT clinic; airway and infection precautions are reviewed; the SLP and otolaryngologist collaborate to select appropriate instrumentation and food/liquid consistencies; informed consent for the special procedure is obtained; the procedure is conducted with videorecording or therapist documentation of compensatory strategies and direct diagnostic findings; results are documented in the medical record with recommendations for rehabilitation and any necessary referrals. Typical site of service is an outpatient clinic specialized in hearing/speech or otorhinolaryngology; the service type is a specialized diagnostic/treatment procedure of the ears, nose, and throat focused on swallowing function beyond a comprehensive office visit.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    92611Motion fluoroscopic evaluation of swallowing function by cine or video recording

    Related Modifiers

    8 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…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    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
    235Z00000X
    261QH0700X
    225X00000X
    213ER0200X
    207RG0300X
    261QA0006X
    111NX0800X
    2278C0205X

    Related ICD-10-CM Codes

    32 rows

    ICD-10-CM CodeDescription
    B95.3Streptococcus pneumoniae as the cause of diseases classified elsewhere
    B95.4Other streptococcus as the cause of diseases classified elsewhere
    G43.909Migraine, unspecified, not intractable, without status migrainosus
    G44.209Tension-type headache, unspecified, not intractable
    H60.391Other infective otitis externa, right ear
    H61.22Impacted cerumen, left ear
    H61.23Impacted cerumen, bilateral
    H90.11Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
    H90.12Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
    H90.3Sensorineural hearing loss, bilateral

    Showing 1–10 of 32

    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-92601-COCHLEAR-IMPLANT-ANALYSIS-PROGRAMMING-UNDER-7

    CPT 92601: Cochlear Implant Analysis and Programming, Patient <7

    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-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.

    Alternative or complementary instrumental assessment when radiographic swallowing dynamics are needed after or instead of 92610
    92612Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recordingMore invasive endoscopic assessment often performed when direct visualization of pharyngeal / laryngeal anatomy during swallowing is required; may follow or substitute 92610
    92614Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recordingPerformed when laryngeal sensory assessment is indicated in addition to swallowing evaluation; may be added to the diagnostic workflow after 92610 findings
    92616Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recordingCombines endoscopic swallowing evaluation and sensory testing; used when comprehensive instrumental assessment is required following or instead of 92610