Most Utilized CPT Codes and Medicare Payment Updates

Anna Hall, AAO-HNS Manager, Health Policy and Regulatory Affairs

Each year, the Academy provides AAO-HNS members with an updated listing of the 100 Current Procedural Terminology (CPT) codes most frequently reported by otolaryngologists to help members better understand national utilization patterns and how recent Medicare payment policy changes may affect their practice.

The data sets reflect all Medicare claims data for physicians enrolled under the otolaryngology specialty designation using Medicare Specialty Code 04. Each chart identifies the CPT codes most commonly reported in its respective site of service, allowing members to compare utilization trends across practice settings. The two data sets include the facility and non-facility settings for the most recent year of available data, 2024. This data is published by the Centers for Medicare & Medicaid Services (CMS) regularly through its annual rulemaking cycle. 

Access the Top 100 ENT Facility and Non-Facility Codes

Updated Valuations and 2026 Payment Rates

This AAO-HNS member resource incorporates updated code valuations and Medicare payment rates for 2026, reflecting policies finalized in the most recent rulemaking cycle—including the new “efficiency adjustment” and noteworthy changes to practice expense methodology. Together, these updates allow members to see not only which otolaryngology services are most frequently reported, but also the Medicare payment amounts for those services in 2026 as a result of recent Medicare payment policy changes. As the AAO-HNS has previously reported, the calendar year (CY) 2026 Medicare Physician Fee Schedule final rule implemented dual conversion factors for qualifying providers (QPs) participating in Advanced Alternative Payment Models (APM) and those who do not. The Academy’s analyses use the CY 2026 non-APM conversion factor (33.4009), as most otolaryngologists fall into the non-QP category.

For hospital outpatient services, the analysis also includes HCPCS code G0463, which Medicare uses to report clinic visits in the hospital outpatient setting. Including this code provides a more complete picture of otolaryngology services furnished in that setting.

For questions about this dataset or to ask a health policy question, contact the Academy’s Health Policy team at healthpolicy@entnet.org.