2025 CPT code 92604
(Active) Effective Date: N/A Medicine - Special Otorhinolaryngologic Services and Procedures Feed
Reprogramming of a cochlear implant for patients 7 years and older.
Modifiers may be applicable to 92604 in certain situations, such as reduced services (modifier 52), discontinued procedures (modifier 53), or distinct procedural services (modifier 59), bilateral procedure (modifier 50), or other circumstance requiring the use of a modifier.
Medical necessity for 92604 is established when a patient with a cochlear implant, age 7 years or older, requires reprogramming of the device due to changes in hearing, device malfunction, discomfort, or the need for optimization based on the patient's individual needs and auditory environment.
The physician evaluates the function of a previously placed cochlear implant in a patient 7 years or older. This includes measuring and adjusting the external transmitter and reprogramming the internal stimulator based on the patient's reported experience with the device. The physician ensures the implant site is healthy, the device is functioning properly, and all electrodes are correctly positioned. Patient and family counseling on device care and use is also provided.
In simple words: The doctor adjusts the programming on a child's cochlear implant (a device that helps them hear) to make sure it's working correctly. This is for children 7 years old or older who already have the implant.
Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming. Do not report 92604 in addition to 92603. For diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, use 92622. For evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s), use 92626. For aural rehabilitation services following auditory osseointegrated implant, see 92630, 92633. For initial and subsequent diagnostic analysis and programming of vestibular implant, see 0728T, 0729T.
Example 1: A 9-year-old patient with a cochlear implant is experiencing difficulty understanding speech in noisy environments. The audiologist performs 92604 to adjust the programming and optimize the device's performance., An 8-year-old patient with a cochlear implant reports discomfort at the implant site. The physician performs 92604 to check for any issues and adjust the magnet strength to alleviate the discomfort., A 7-year-old patient receives their first reprogramming of their cochlear implant since the initial placement and programming, using code 92604.
Documentation should include the patient's age, details of the cochlear implant (type, model, date of original placement), the patient's reported experiences with the device, the specific adjustments made to the external transmitter and internal stimulator programming, any counseling provided to the patient/family, and the overall outcome of the reprogramming session.
- Revenue Code: T2D
- Specialties:Audiology, Otolaryngology
- Place of Service:Office, Outpatient Hospital, or other outpatient facilities.