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CPT 92557

Comprehensive Hearing Assessment

National PFS baseline · Q1 2026

92557 · Historical

GPCIs 1.000 · Participating · Before sequestration

Find the locality-adjusted allowed amount

Nationally priced under PFS, using the RVU formula.

See everything that changed in Q1 2026 Get alerts for this code

The national PFS baseline was $35.74 for CPT 92557 in the office (non-facility) setting and $25.72 in a facility under the Q1 2026 Physician Fee Schedule, effective January 2026. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Calculation evidence

Physician relative value file (Q1 2026) · rvu26a-updated-12-29-2025.zip (PPRRVU2026_Jan_nonQPP.csv row 11,731)

Compact facts

Why are the facility and non-facility amounts different?

Only the practice-expense RVU changes with the setting. For 92557 it's 0.46 RVUs in the office versus 0.16 in a facility—the whole $10.02 gap between $35.74 and $25.72. In an office the practice bears the overhead, so Medicare pays more; in a hospital or ASC the facility bills its own fee, so the professional payment is lower. See facility vs non-facility.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).

About this code

Also known as Hearing test

What could change this amount? Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

Service location and setting · Participation and payment shares

Facility/non-facility Applies Professional/technical component Applies Bilateral adjustment Applies
Other payment indicators (7)

Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

Compare payment localities

The national baseline uses GPCI 1.000. These locality-adjusted allowed amounts use each payment locality's own GPCIs. Select a state to see its localities.

Maine: $34.38–$35.48 across 2 localities ME Wisconsin: $34.86 WI Vermont: $35.42 VT New Hampshire: $36.33 NH Montana: $35.74 MT North Dakota: $35.54 ND Minnesota: $35.95 MN Michigan: $34.45–$35.43 across 2 localities MI New York: $34.87–$40.21 across 5 localities NY Massachusetts: $36.81–$39.50 across 2 localities MA Rhode Island: $36.59 RI Washington: $36.73–$40.17 across 2 localities WA Idaho: $34.33 ID Wyoming: $35.65 WY South Dakota: $35.52 SD Iowa: $34.23 IA Illinois: $34.59–$36.55 across 4 localities IL Indiana: $34.45 IN Ohio: $34.40 OH Pennsylvania: $34.46–$36.79 across 2 localities PA New Jersey: $37.99–$39.48 across 2 localities NJ Connecticut: $37.39 CT Oregon: $35.58–$37.68 across 2 localities OR Nevada: $35.70 NV Utah: $34.78 UT Colorado: $36.89 CO Nebraska: $34.35 NE Missouri: $33.61–$35.00 across 3 localities MO Kentucky: $34.01 KY West Virginia: $33.87 WV Virginia: $35.38 VA Maryland: $36.10–$37.26 across 2 localities MD Delaware: $35.62 DE California: $37.40–$44.58 across 29 localities CA Arizona: $35.21 AZ New Mexico: $34.53 NM Kansas: $34.10 KS Oklahoma: $34.02 OK Arkansas: $33.41 AR Tennessee: $34.19 TN North Carolina: $34.59 NC South Carolina: $34.52 SC District of Columbia: $39.59 DC Texas: $34.33–$36.63 across 8 localities TX Louisiana: $33.96–$34.88 across 2 localities LA Mississippi: $33.52 MS Alabama: $33.67 AL Georgia: $34.14–$36.11 across 2 localities GA Florida: $35.23–$36.88 across 3 localities FL Alaska: $46.61 AK Hawaii: $37.70 HI
$33–$36 $36–$38 $38–$40 $40–$42 $42–$44 $44–$47

Highest-paying locality

$46.61

AK flag Alaska , AK

Lowest-paying locality

$33.41

AR flag Arkansas, AR

92557 non-facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $46.61 Locality 02102-01 Washington, DC flag Washington, DC $39.59 Locality 12202-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $39.48 Locality 12402-01 Honolulu, HI flag Honolulu, HI $37.70 Locality 01212-01 Hartford, CT flag Hartford, CT $37.39 Locality 13102-00 Denver, CO flag Denver, CO $36.89 Locality 04112-01 Providence, RI flag Providence, RI $36.59 Locality 14412-01
Show 24 more metros
Minneapolis, MN flag Minneapolis, MN $35.95 Locality 06202-00 Las Vegas, NV flag Las Vegas, NV $35.70 Locality 01312-00 Portland, ME flag Portland, ME $35.48 Locality 14112-03 Richmond, VA flag Richmond, VA $35.38 Locality 11302-00 Tampa, FL flag Tampa, FL $35.23 Locality 09102-99 Phoenix, AZ flag Phoenix, AZ $35.21 Locality 03102-00 San Antonio, TX flag San Antonio, TX $34.92 Locality 04412-99 Buffalo, NY flag Buffalo, NY $34.87 Locality 13282-99 Milwaukee, WI flag Milwaukee, WI $34.86 Locality 06302-00 Salt Lake City, UT flag Salt Lake City, UT $34.78 Locality 03502-09 Charlotte, NC flag Charlotte, NC $34.59 Locality 11502-00 Albuquerque, NM flag Albuquerque, NM $34.53 Locality 04212-05 Charleston, SC flag Charleston, SC $34.52 Locality 11202-01 Pittsburgh, PA flag Pittsburgh, PA $34.46 Locality 12502-99 Indianapolis, IN flag Indianapolis, IN $34.45 Locality 08102-00 Columbus, OH flag Columbus, OH $34.40 Locality 15202-00 Omaha, NE flag Omaha, NE $34.35 Locality 05402-00 Boise, ID flag Boise, ID $34.33 Locality 02202-00 Des Moines, IA flag Des Moines, IA $34.23 Locality 05102-00 Nashville, TN flag Nashville, TN $34.19 Locality 10312-35 Wichita, KS flag Wichita, KS $34.10 Locality 05202-00 Oklahoma City, OK flag Oklahoma City, OK $34.02 Locality 04312-00 Louisville, KY flag Louisville, KY $34.01 Locality 15102-00 Birmingham, AL flag Birmingham, AL $33.67 Locality 10112-00
Maine: $25.16–$25.55 across 2 localities ME Wisconsin: $25.26 WI Vermont: $25.50 VT New Hampshire: $25.90 NH Montana: $25.72 MT North Dakota: $25.52 ND Minnesota: $25.64 MN Michigan: $25.30–$25.76 across 2 localities MI New York: $25.35–$28.30 across 5 localities NY Massachusetts: $26.25–$27.54 across 2 localities MA Rhode Island: $26.24 RI Washington: $26.18–$27.87 across 2 localities WA Idaho: $25.12 ID Wyoming: $25.63 WY South Dakota: $25.50 SD Iowa: $25.06 IA Illinois: $25.44–$26.32 across 4 localities IL Indiana: $25.16 IN Ohio: $25.26 OH Pennsylvania: $25.26–$26.36 across 2 localities PA New Jersey: $27.04–$27.86 across 2 localities NJ Connecticut: $26.60 CT Oregon: $25.60–$26.55 across 2 localities OR Nevada: $25.67 NV Utah: $25.36 UT Colorado: $26.23 CO Nebraska: $25.10 NE Missouri: $24.97–$25.46 across 3 localities MO Kentucky: $25.10 KY West Virginia: $25.16 WV Virginia: $25.53 VA Maryland: $25.96–$26.51 across 2 localities MD Delaware: $25.72 DE California: $26.42–$30.13 across 29 localities CA Arizona: $25.50 AZ New Mexico: $25.34 NM Kansas: $25.04 KS Oklahoma: $25.07 OK Arkansas: $24.80 AR Tennessee: $25.08 TN North Carolina: $25.24 NC South Carolina: $25.26 SC District of Columbia: $27.79 DC Texas: $25.21–$26.03 across 8 localities TX Louisiana: $25.09–$25.45 across 2 localities LA Mississippi: $24.89 MS Alabama: $24.91 AL Georgia: $25.21–$25.93 across 2 localities GA Florida: $25.65–$26.45 across 3 localities FL Alaska: $35.94 AK Hawaii: $26.31 HI
$25–$27 $27–$29 $29–$30 $30–$32 $32–$34 $34–$36

Highest-paying locality

$35.94

AK flag Alaska , AK

Lowest-paying locality

$24.80

AR flag Arkansas, AR

92557 facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $35.94 Locality 02102-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $27.86 Locality 12402-01 Washington, DC flag Washington, DC $27.79 Locality 12202-01 Hartford, CT flag Hartford, CT $26.60 Locality 13102-00 Honolulu, HI flag Honolulu, HI $26.31 Locality 01212-01 Providence, RI flag Providence, RI $26.24 Locality 14412-01 Denver, CO flag Denver, CO $26.23 Locality 04112-01
Show 24 more metros
Las Vegas, NV flag Las Vegas, NV $25.67 Locality 01312-00 Tampa, FL flag Tampa, FL $25.65 Locality 09102-99 Minneapolis, MN flag Minneapolis, MN $25.64 Locality 06202-00 Portland, ME flag Portland, ME $25.55 Locality 14112-03 Richmond, VA flag Richmond, VA $25.53 Locality 11302-00 Phoenix, AZ flag Phoenix, AZ $25.50 Locality 03102-00 San Antonio, TX flag San Antonio, TX $25.41 Locality 04412-99 Salt Lake City, UT flag Salt Lake City, UT $25.36 Locality 03502-09 Buffalo, NY flag Buffalo, NY $25.35 Locality 13282-99 Albuquerque, NM flag Albuquerque, NM $25.34 Locality 04212-05 Columbus, OH flag Columbus, OH $25.26 Locality 15202-00 Pittsburgh, PA flag Pittsburgh, PA $25.26 Locality 12502-99 Charleston, SC flag Charleston, SC $25.26 Locality 11202-01 Milwaukee, WI flag Milwaukee, WI $25.26 Locality 06302-00 Charlotte, NC flag Charlotte, NC $25.24 Locality 11502-00 Indianapolis, IN flag Indianapolis, IN $25.16 Locality 08102-00 Boise, ID flag Boise, ID $25.12 Locality 02202-00 Louisville, KY flag Louisville, KY $25.10 Locality 15102-00 Omaha, NE flag Omaha, NE $25.10 Locality 05402-00 Nashville, TN flag Nashville, TN $25.08 Locality 10312-35 Oklahoma City, OK flag Oklahoma City, OK $25.07 Locality 04312-00 Des Moines, IA flag Des Moines, IA $25.06 Locality 05102-00 Wichita, KS flag Wichita, KS $25.04 Locality 05202-00 Birmingham, AL flag Birmingham, AL $24.91 Locality 10112-00

Look up your exact locality →

Q1 2026 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range—its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.

How this amount is computed Copy link

CPT 92557 has a work RVU of 0.60, a non-facility practice expense RVU of 0.46, a facility practice expense RVU of 0.16 and a malpractice RVU of 0.01—for total non-facility RVUs of 1.07 and total facility RVUs of 0.77 in the Q1 2026 release.

amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Release Q1 2026
Component RVU
Work RVU 0.60
Practice expense RVU (non-facility) 0.46
Practice expense RVU (facility) 0.16
Malpractice RVU 0.01

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead—higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.

Payment review for 92557 Copy link

Three published payment rules can change what 92557 allows on a claim: the office/facility differential, bilateral pricing already in the RVUs and documentation-restricted assistant-at-surgery payment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

What to reconcile

  • Check the place-of-service code before attributing the gap to the payer: office and facility pricing differ by $10.02 nationally at GPCI 1.000, before any locality adjustment.
  • Check whether a second side was billed separately—the published RVUs already price both sides, so there is no additional amount behind that line.
  • Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
  • Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.

Nearby payment lines

National Q1 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Why compare Office Facility
92556 Prices the same in either setting, unlike this code $46.43 $46.43
92555 Prices the same in either setting, unlike this code $29.73 $29.73
92562 Prices the same in either setting, unlike this code $49.10 $49.10
Check an actual payment Model this code in a contract

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Payment rules

Global period: what 92557's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Billing policy Copy link

What 92557's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.

Policy Value What it means
Bilateral surgery 2 RVUs already reflect bilateral pricing. The published RVUs already account for a bilateral procedure—no additional bilateral adjustment applies on top of the fee schedule amount.
Assistant at surgery 0 Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity.
Co-surgeons 0 Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure.
Team surgery 0 Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure.
Multiple procedures 0 No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date—each is treated as unrelated.
Professional/technical split 7 Value 7. Indicator value not recognized.

Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link

National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

Modifier What it means Amount
-26/TC Professional/technical split Not payable
-50 Bilateral procedure (100%) $35.74
-80/81/82 Assistant surgeon (physician) (16%) $5.72 If documented
-AS Assistant at surgery (PA, NP, or CNS) (13.6%) $4.86 If documented
-62 Co-surgeons, each Not payable
-66 Team surgery Not payable

These apply standard MPFS percentages—assistant surgeon 16%, co-surgeon 62.5%, bilateral 150%—to the national non-facility amount above, and require both the RVU inputs and the applicable payment rule as evidence. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator pays it only when supporting documentation of medical necessity is submitted—an unpaid claim without that documentation is not an underpayment.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 92557.

See every current NCCI pair for 92557 →

Allowed amount, program payment, and patient share Copy link

These figures use the same national baseline, with different participation and payment assumptions.

Computed from the Q1 2026 CMS release

Medicare allowed amount

What Medicare recognizes as the full price for 92557 in the office (non-facility) setting. Every figure below derives from it.

$35.74
Medicare's share

80% of the allowed amount, before the ~2% sequestration cut.

$28.59
Patient coinsurance

The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.

$7.15
Limiting charge

The ceiling a non-participating provider can bill a patient on an unassigned claim—109.25% of the allowed amount.

$39.04

National Q1 2026 figures at GPCI 1.000. Adjust for your locality and sequestration, or expand the explanations below for each figure in full.

Is $35.74 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($28.59) and the patient owes 20% coinsurance ($7.15). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 92557?

$33.95 in the office (non-facility) setting—95% of the $35.74 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 92557?

$39.04 in the office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $35.74 amount above. The non-participating amount is 95% of the fee schedule rate ($33.95), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

Common payment questions Copy link

Why would a Medicare claim for 92557 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

History

Rate history by release Copy link

National non-facility amount for 92557 across quarterly releases. +30.0% increase since Q1 2013 · high $39.08 in Q1 2021

$39 $35 $31 $27 $24 Q1 2013 · $27.50 Q2 2014 · $37.97 (+38.1%) Q3 2014 · $37.97 (0.0%) Q4 2014 · $37.97 (0.0%) Q1 2015 · $37.54 (-1.1%) Q2 2015 · $37.54 (0.0%) Q3 2015 · $37.54 (0.0%) Q4 2015 · $37.73 (+0.5%) Q1 2016 · $37.95 (+0.6%) Q2 2016 · $37.95 (0.0%) Q3 2016 · $37.95 (0.0%) Q4 2016 · $37.95 (0.0%) Q1 2017 · $38.40 (+1.2%) Q2 2017 · $38.40 (0.0%) Q3 2017 · $38.40 (0.0%) Q4 2017 · $38.40 (0.0%) Q1 2018 · $38.52 (+0.3%) Q2 2018 · $38.52 (0.0%) Q3 2018 · $38.52 (0.0%) Q4 2018 · $38.52 (0.0%) Q1 2019 · $38.92 (+1.0%) Q2 2019 · $38.92 (0.0%) Q3 2019 · $38.92 (0.0%) Q4 2019 · $38.92 (0.0%) Q1 2020 · $38.98 (+0.2%) Q2 2020 · $38.98 (0.0%) Q3 2020 · $38.98 (0.0%) Q4 2020 · $38.98 (0.0%) Q1 2021 · $39.08 (+0.3%) Q2 2021 · $39.08 (0.0%) Q3 2021 · $39.08 (0.0%) Q4 2021 · $39.08 (0.0%) Q1 2022 · $38.41 (-1.7%) Q2 2022 · $38.41 (0.0%) Q3 2022 · $38.41 (0.0%) Q4 2022 · $38.41 (0.0%) Q1 2023 · $37.28 (-2.9%) Q2 2023 · $37.28 (0.0%) Q3 2023 · $37.28 (0.0%) Q4 2023 · $37.28 (0.0%) Q1 2024 · $35.69 (-4.3%) Q1 2024 · $36.28 (+1.7%) Q2 2024 · $36.28 (0.0%) Q3 2024 · $36.28 (0.0%) Q4 2024 · $36.28 (0.0%) Q1 2025 · $35.26 (-2.8%) Q2 2025 · $35.26 (0.0%) Q3 2025 · $35.26 (0.0%) Q4 2025 · $35.26 (0.0%) Q1 2026 · $35.74 (+1.4%) Q2 2026 · $35.74 (0.0%) Q3 2026 · $35.74 (0.0%) Q4 2026 · $35.74 (0.0%) Q1 2013 Q3 2016 Q2 2019 Q4 2021 Q2 2024 Q4 2026
Non-facility Facility
Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 A $35.74 (0.0% no change ) $25.72 (0.0% no change )

This is a 1.4% increase from the previous quarter.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

The 92557 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Beyond Medicare

Contracted rate: % of Medicare Copy link

Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 92557 pays at that rate—$35.74 is 100%.

We want to build this: store your multipliers once, and every code page shows your rate instead of Medicare's. Tell us if you'd use it →

See how to find your contract's actual percentage.

Usage & related

How often 92557 is billed Copy link

Across Original Medicare in CY2024, 92557 ranked #146 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Beneficiaries
1.2M
Office + facility patients combined
Services
1.3M
Times it was billed
Allowed
$45.4M
Total Medicare allowed dollars
Compare: ↑ #145 more popular · 00731 ↓ #147 less popular · 64590

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2026 fee schedule above.

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q1 2026 release (effective January 2026). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q1 2026) · rvu26a-updated-12-29-2025.zip (PPRRVU2026_Jan_nonQPP.csv row 11,731)

Conversion factor $33.4009 read from the same file, row 11, column 26.

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 92557 National PFS baseline: Office (non-facility) $35.74; Facility $25.72 (Q1 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/92557/2026/A