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CPT 92610: Special Otorhinolaryngologic Diagnostic/Treatment Procedure
CPT code 92610 covers special diagnostic or therapeutic otorhinolaryngologic procedures that are distinct from routine ENT evaluations or office visits. Nationally, this code is used to bill for targeted procedures related to swallowing and upper aerodigestive tract function that require procedural technique or instrumentation beyond a standard visit. Use of 92610 signals a focused, procedure-based service and has implications for clinical documentation, coding compliance, and payer adjudication across specialty practices.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, common billing modifiers and coding relationships, and clinical context linking 92610 to swallowing assessments performed in otolaryngology and speech/swallowing clinics.
Readers will learn: the clinical scope and appropriate service setting for CPT code 92610, commonly reported companion and related CPT codes used for swallowing evaluations, typical diagnosis links such as dysphagia subtypes, and considerations that affect billing and reimbursement. The report also summarizes expected sites of service and professional specialties most frequently associated with this code. Data not available in the input where applicable is noted.
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Billing Code Overview
CPT code 92610 describes special otorhinolaryngologic procedures of the ears, nose, and throat that are diagnostic or therapeutic and are not generally included in a comprehensive otorhinolaryngologic evaluation or routine office visit. These services focus on targeted, procedure-based assessment or treatment related to swallowing and related upper aerodigestive tract function.
Service type: Special otorhinolaryngologic diagnostic/treatment procedures
Typical site of service: Otolaryngology or speech and swallowing clinics; outpatient specialty clinics and procedural suites
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.