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CPT code 31628: Lung biopsy, single lobe2026 Medicare rate & RVUs in Delaware

Report this bronchoscopy when transbronchial lung tissue is sampled from one lobe; use the companion add-on code for each additional lobe.

CMS RVU26DEffective Oct 1, 2026One payment locality43.3K Medicare services in 2024

In Delaware, Medicare pays $404.57 for 31628 in the office and $157.73 when it’s performed in a hospital or facility.

$404.57Office (non-facility)
$157.73Hospital or facility
−1.0%vs the national office rate ($408.49)

Check a contract rate as a % of Medicare · 31628 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 31628 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 31628 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 31628 covers

A pulmonologist or interventional pulmonologist passes a bronchoscope into the airways and obtains lung tissue through the bronchial wall, typically with biopsy forceps. The code represents sampling from one lobe during a diagnostic evaluation, such as investigating diffuse lung disease, infection, or a suspected pulmonary lesion. The procedure is commonly performed in a hospital or ambulatory surgery setting; imaging guidance may be used.

Choose this code based on the transbronchial biopsy method and one lobe sampled, not the number of tissue fragments. Record the biopsy technique, sampled lobe, and findings; report 31632 for each additional lobe sampled in the same session. When related endoscopies are performed together, CMS applies endoscopy family pricing. The 0-day global period includes same-day preoperative and postoperative care. Bilateral adjustment is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Delaware compares for 31628

Across 109 of 109 payment localities, the office rate for 31628 runs from $363.40 in Arkansas to $540.69 in San Benito County, CA. Delaware pays $404.57. The RVUs are the same everywhere; the geographic indexes change the dollars.

31628 in Delaware vs other payment areas
  1. Delaware · this page$404.57
  2. Los Angeles, CA · California$461.12+$56.55
  3. Washington, DC area · District of Columbia$466.16+$61.59
  4. Miami, FL · Florida$436.90+$32.33
  5. Chicago, IL · Illinois$424.99+$20.42
  6. Manhattan, NY · New York$468.02+$63.45
  7. Alaska · Alaska$479.65+$75.08

Other areas in Delaware first, then benchmark localities. Bars start at $0.

Every other payment area

31628 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$368.47$149.86
ArkansasArkansas$363.40$148.79
ArizonaArizona$398.17$156.07
Bakersfield, CACalifornia$433.44$159.62
Chico, CACalifornia$432.41$158.58
El Centro, CACalifornia$432.46$158.64
Fresno, CACalifornia$432.41$158.58
Hanford, CACalifornia$432.41$158.58

31628 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$363.40

$486.55

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
31628 office rate range by state
State / territoryOffice rate rangeLocalities
AK$479.651
AL$368.471
AR$363.401
AZ$398.171
CA$432.41–$540.6929
CO$425.511
CT$434.831
DC$466.161
DE$404.571
FL$401.63–$436.903
GA$380.16–$415.572
GU$442.471
HI$442.471
IA$377.881
ID$380.131
IL$390.17–$425.424
IN$382.251
KS$375.961
KY$376.261
LA$375.61–$393.362
MA$423.05–$466.712
MD$412.13–$466.163
ME$381.77–$401.892
MI$385.39–$406.192
MN$408.911
MO$369.30–$394.983
MS$366.431
MT$408.471
NC$385.631
ND$401.951
NE$379.931
NH$418.671
NJ$440.12–$461.632
NM$387.311
NV$406.931
NY$391.12–$478.625
OH$384.061
OK$375.871
OR$404.09–$438.812
PA$384.77–$424.262
PR$411.431
RI$418.801
SC$385.411
SD$401.171
TN$377.741
TX$382.34–$423.828
UT$390.451
VA$400.46–$466.162
VI$411.431
VT$400.231
WA$422.30–$476.252
WI$389.031
WV$376.311
WY$405.631

See 31628 in every payment locality

How the 31628 rate is calculated

Each of 31628’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 31628

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.46

3.46 RVUs× 1.000 GPCI

Practice expense8.44

8.44 RVUs× 1.000 GPCI

Malpractice0.33

0.33 RVUs× 1.000 GPCI

Adjusted RVUs

12.2300

Conversion factor

$33.4009

Medicare rate

$408.49

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Delaware inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,637

Code
31628
Physician work
3.46
Practice expense
8.44
Malpractice
0.33

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 31628 in Delaware
ComponentRVULocality factorAdjusted
Physician work3.46× 1.0053.4773
Practice expense8.44× 0.9888.3387
Malpractice0.33× 0.8990.2967
Total RVUs12.1127
Conversion factor× 33.4009

Office rate, Delaware$404.57

Office: (3.46 × 1.005 + 8.44 × 0.988 + 0.33 × 0.899) × $33.4009 = $404.57

Facility: (3.46 × 1.005 + 0.96 × 0.988 + 0.33 × 0.899) × $33.4009 = $157.73

Open 31628 in the RVU calculator

Payment rules and modifiers for 31628

The CMS indicators that decide how 31628 is paid alongside other services.

CMS payment indicators · 31628

Lung biopsy, single lobe

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

31628 without 51 · national office

$408.49

Lung biopsy, single lobe

31628-51 · Second procedure: 50%

$204.25

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 31628

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 31628
CodeHow it relatesOffice range, Delaware
Add-on codes
31632Lung biopsy, each additional lobeAdd-on code for transbronchial lung biopsy in each additional lobe.$68.31
31627Navigational bronchoscopy, computer-assisted image guidanceNavigation add-on that may accompany bronchoscopy for targeting a pulmonary lesion.$1,141.99
Used instead
31625Bronchoscopy biopsy, airway tissue samplingBiopsy of an endobronchial site rather than lung parenchyma.$380.33
31629Bronchoscopic biopsy, needle aspiration biopsyUses transbronchial needle sampling rather than forceps lung biopsy.$492.05

How 31628 has changed in Delaware

31628 · Office / nonfacility

$404.57

Effective 2026-10-01

The base rate is $50.70 higher than on 2025-10-01, moving from $353.87 to $404.57 (14.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $353.87changed to$404.57

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.55 changed to 3.46
    • Practice expense RVU 7.14 changed to 8.44
    • Malpractice RVU 0.29 changed to 0.33
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $368.43changed to$353.87

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.25 changed to 7.14
    • Malpractice RVU 0.31 changed to 0.29

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $362.42changed to$368.43

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $378.08changed to$362.42

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 0.30 changed to 0.31
    • Work GPCI 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $397.00changed to$378.08

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.48 changed to 7.25
    • Malpractice RVU 0.28 changed to 0.30
    • Work GPCI 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $395.72changed to$397.00

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.37 changed to 7.48
    • Malpractice RVU 0.26 changed to 0.28

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $381.31changed to$395.72

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 6.58 changed to 7.37
    • Malpractice RVU 0.27 changed to 0.26
    • Work GPCI 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $373.32changed to$381.31

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 6.35 changed to 6.58
    • Malpractice RVU 0.28 changed to 0.27
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $368.18changed to$373.32

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.21 changed to 6.35
    • Malpractice RVU 0.29 changed to 0.28

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $366.71changed to$368.18

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 6.17 changed to 6.21
    • Malpractice RVU 0.28 changed to 0.29
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $436.51changed to$366.71

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.80 changed to 3.55
    • Practice expense RVU 7.78 changed to 6.17
    • Malpractice RVU 0.30 changed to 0.28
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $390.69changed to$436.51

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 6.49 changed to 7.78
    • Malpractice RVU 0.31 changed to 0.30

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $388.74changed to$390.69

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $390.44changed to$388.74

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.55 changed to 6.49
    • Malpractice RVU 0.29 changed to 0.31
    • Practice expense GPCI 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $401.61changed to$390.44

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.43 changed to 6.55
    • Malpractice RVU 0.30 changed to 0.29
    • Practice expense GPCI 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $401.61

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$404.57$157.73RVU26D
2026-07-01$404.57$157.73RVU26C
2026-04-01$404.57$157.73RVU26B
2026-01-01$404.57$157.73RVU26A
2025-10-01$353.87$166.80RVU25D
2025-07-01$353.87$166.80RVU25C
2025-04-01$353.87$166.80RVU25B
2025-01-01$353.87$166.80RVU25A
2024-10-01$368.43$171.62RVU24D
2024-07-01$368.43$171.62RVU24C
2024-04-01$368.43$171.62RVU24B
2024-03-09$368.43$171.62RVU24AR
2024-01-01$362.42$168.82RVU24A
2023-10-01$378.08$174.02RVU23D
2023-07-01$378.08$174.02RVU23C
2023-04-01$378.08$174.02RVU23B
2023-01-01$378.08$174.02RVU23A
2022-10-01$397.00$178.43RVU22D
2022-07-01$397.00$178.43RVU22C
2022-04-01$397.00$178.43RVU22B
2022-01-01$397.00$178.43RVU22A
2021-10-01$395.72$179.26RVU21D
2021-07-01$395.72$179.26RVU21C
2021-04-01$395.72$179.26RVU21B
2021-01-01$395.72$179.26RVU21A
2020-10-01$381.31$184.55RVU20D
2020-07-01$381.31$184.55RVU20C
2020-04-01$381.31$184.55RVU20B
2020-01-01$381.31$184.55RVU20A
2019-10-01$373.32$185.30RVU19D
2019-07-01$373.32$185.30RVU19C
2019-04-01$373.32$185.30RVU19B
2019-01-01$373.32$185.30RVU19A
2018-10-01$368.18$186.23RVU18D
2018-07-01$368.18$186.23RVU18C
2018-04-01$368.18$186.23RVU18B
2018-01-01$368.18$186.23RVU18AR1
2017-10-01$366.71$186.09RVU17D
2017-07-01$366.71$186.09RVU17C
2017-04-01$366.71$186.09RVU17B
2017-01-01$366.71$186.09RVU17A
2016-10-01$436.51$198.42RVU16D
2016-07-01$436.51$198.42RVU16C
2016-04-01$436.51$198.42RVU16B
2016-01-01$436.51$198.42RVU16A
2015-10-01$390.69$201.00RVU15D
2015-07-01$390.69$201.00RVU15C
2015-04-01$388.74$200.00RVU15B
2015-01-01$388.74$200.00RVU15A
2014-10-01$390.44$198.20RVU14D
2014-07-01$390.44$198.20RVU14C
2014-04-01$390.44$198.20RVU14B
2014-01-01$390.44$198.20RVU14A
2013-10-01$401.61$192.40RVU13D
2013-07-01$401.61$192.40RVU13C
2013-04-01$401.61$192.40RVU13B
2013-01-01$401.61$192.40RVU13AR

Price 31628 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

31628 billing questions

How is this different from 31625?

31628 is for tissue sampled from lung parenchyma through the bronchial wall. Code 31625 describes biopsy of an endobronchial site, such as visible airway mucosa or a lesion within the bronchus.

Does the number of biopsy fragments change the code?

No. This code covers transbronchial lung biopsy in one lobe, regardless of the number of tissue fragments obtained. Use 31632 for each additional lobe sampled.

Can diagnostic bronchoscopy be reported separately?

The inspection needed to perform the biopsy is part of the bronchoscopy service. Do not separately report a diagnostic bronchoscopy for that same inspection during the biopsy session.

Should modifier 50 be used for biopsies in both lungs?

No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service according to the lobes sampled, including the additional-lobe add-on when applicable.

What documentation supports reporting 31628 with 31632?

Document the transbronchial biopsy method and identify each lobe sampled. The record should support one lobe for 31628 and each additional lobe reported with 31632.

How does Medicare price this with another related endoscopy?

CMS applies endoscopy family pricing when related endoscopies are performed together. The 0-day global period includes same-day preoperative and postoperative care.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 31628PPRRVU2026_Oct_nonQPP.csv, line 3,637 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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