CPT 92625: Tinnitus Assessment, Audiology Diagnostic Evaluation
Medicare pays $68 and commercial payers pay $177 on average nationally for this procedure.
CPT code 92625 documents an evaluation focused on tinnitus, the subjective perception of ringing, roaring, or static without external sound, performed as an audiology diagnostic assessment typically in an outpatient audiology or otolaryngology clinic setting to characterize the symptom and guide further diagnostic workup.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
Medicare's mean rate of $68 stands well below BUCA's average commercial mean of $177 for CPT 92625, indicating a substantial gap between public and this commercial benchmark. The difference of $109 underscores how commercial average reimbursement can be markedly higher than Medicare for this service, with Medicare sitting near BUCA's lower quartile ($65) while BUCA's median is $166.
Dispersion varies notably by payer. Blue Cross Blue Shield shows the widest interquartile spread (P75 $288.30 minus P25 $195.90 = $92.40), reflecting high variability. UnitedHealth Group and Cigna have moderate spreads (UnitedHealth Group IQR $136.50−$69.40 = $67.10; Cigna IQR $127.50−$67.00 = $60.50). Aetna is the tightest among commercial carriers with an IQR of $73.00−$60.00 = $13.00, indicating more consistency in contracted rates.