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The CPT® Code 92604 refers to the diagnostic analysis of a cochlear implant for patients aged 7 years or older, specifically focusing on subsequent reprogramming. A cochlear implant is a sophisticated electronic device designed to provide a sense of sound to individuals with severe bilateral sensorineural hearing loss, which is a type of hearing loss caused by damage to the inner ear or the auditory nerve. The device operates by converting sound waves into electrical signals that stimulate the auditory nerve fibers, allowing the brain to perceive sound. The cochlear implant consists of two main components: an internal part that is surgically implanted within the cochlea and an external part that includes a microphone and a speech processor. The process of utilizing a cochlear implant begins with the surgical implantation of the internal processor, followed by the connection and programming of the external components approximately four weeks post-surgery. The external components, which include a microphone, a speech processor, transmitting cables, and a transmitting coil, work together to capture sound, convert it into electrical signals, and transmit these signals to the implanted receiver/stimulator. During the initial programming, a 'map' is created for the patient, which involves determining the threshold levels of electrical stimulation necessary for sound perception (T-level) and the maximum comfortable intensity of sound (M or C-levels). This mapping process is crucial as it customizes the device's settings to the individual's hearing capabilities. Following the initial programming, periodic evaluations and reprogramming of the external device are necessary to ensure optimal performance and adaptation to the patient's changing hearing needs. CPT® Code 92604 is specifically used for patients aged 7 years and older, while codes 92601 and 92602 are designated for younger patients.
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The diagnostic analysis and subsequent reprogramming of a cochlear implant, as described by CPT® Code 92604, is indicated for patients aged 7 years or older who have undergone cochlear implantation and require ongoing adjustments to their device settings. The procedure is essential for individuals experiencing changes in their hearing abilities or those who may not be receiving optimal auditory input from their cochlear implant. The following conditions may warrant the use of this procedure:
The procedure associated with CPT® Code 92604 involves several critical steps to ensure the cochlear implant is functioning optimally for the patient. The following outlines the procedural steps:
Post-procedure care following the diagnostic analysis and reprogramming of a cochlear implant involves monitoring the patient’s adaptation to the new settings. Patients may experience a period of adjustment as they become accustomed to the changes in sound perception. It is important for healthcare providers to schedule follow-up appointments to assess the effectiveness of the reprogramming and make any necessary adjustments. Additionally, patients should be educated on the importance of regular evaluations to maintain optimal hearing performance and to address any concerns that may arise regarding their cochlear implant functionality.
| Short Descr | REPROGRAM COCHLEAR IMPLT 7/> | Medium Descr | ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG | Long Descr | Diagnostic analysis of cochlear implant, age 7 years or older; subsequent reprogramming | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 7 - Physical Therapy Service, for which Payment may not be Made | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 02 - Procedure must be performed under the direct supervision of a physician. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | T2D - Other tests - other | MUE | 1 | CCS Clinical Classification | 220 - Ophthalmologic and otologic diagnosis and treatment |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | AB | Audiology service furnished personally by an audiologist without a physician/npp order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GA | Waiver of liability statement issued as required by payer policy, individual case | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | GZ | Item or service expected to be denied as not reasonable and necessary | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GC | This service has been performed in part by a resident under the direction of a teaching physician | GK | Reasonable and necessary item/service associated with a ga or gz modifier | GN | Services delivered under an outpatient speech language pathology plan of care | GT | Via interactive audio and video telecommunication systems | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | HA | Child/adolescent program | KX | Requirements specified in the medical policy have been met | UC | Medicaid level of care 12, as defined by each state |
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| 2024-01-01 | Changed | Guideline information changed. |
| 2013-01-01 | Changed | Short Descriptor changed. |
| 2003-01-01 | Added | First appearance in code book in 2003. |
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