CPT code 31654: Bronchoscopy guidance, peripheral lesion localization2026 Medicare rate & RVUs
Add-on bronchoscopy guidance using endobronchial ultrasound to localize peripheral pulmonary lesions during a separately reported bronchoscopic procedure, commonly for tissue sampling.
Medicare pays $131.27 for 31654 nationally in the office and $59.79 in a hospital or facility. Local office rates run $117.72–$170.16.
Medicare rate · 31654
Bronchoscopy guidance, peripheral lesion localization
- Work RVUs
- 1.37
- Total RVUs
- 3.93
- Global days
- ZZZ
National rate · 2026
$131.27
Office setting, before claim adjustments.
See every locality for 31654 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 31654 covers
During bronchoscopy, the physician advances an endobronchial ultrasound probe to locate a peripheral lung lesion and guide the bronchoscopic procedure toward it. This is commonly used by pulmonologists and interventional pulmonologists when a lung nodule or other peripheral abnormality is difficult to target by direct airway visualization. The code represents EBUS guidance for peripheral lesions, not EBUS-guided sampling of mediastinal or hilar lymph nodes.
Report 31654 only with a primary bronchoscopy procedure; examples of tissue-acquisition procedures that may be paired include transbronchial lung biopsy (31628) and transbronchial needle aspiration (31629), when performed. Documentation should identify the peripheral target and describe use of EBUS to localize or guide work on that lesion. CMS treats this as an add-on code, paid within the primary procedure's global period; it is not reported as a standalone service.
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.
Where 31654 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$117.72 to $170.16
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $119.24 | $56.69 |
| Alaska | $157.47 | $81.35 |
| Arizona | $128.12 | $58.86 |
| Arkansas | $117.72 | $56.32 |
| Atlanta, GA | $133.57 | $60.95 |
| Austin, TX | $135.57 | $59.95 |
| Bakersfield, CA | $138.23 | $59.89 |
| Baltimore area, MD | $138.95 | $62.26 |
| Beaumont, TX | $123.65 | $58.61 |
| Brazoria, TX | $129.95 | $59.11 |
| Chicago, IL | $137.61 | $65.78 |
| Chico, CA | $137.82 | $59.48 |
| Colorado | $136.06 | $60.01 |
| Connecticut | $139.34 | $62.36 |
| Dallas, TX | $130.74 | $59.54 |
| Delaware | $130.08 | $59.46 |
| Detroit, MI | $131.40 | $62.43 |
| East St. Louis, IL | $129.18 | $63.42 |
| El Centro, CA | $137.84 | $59.50 |
| Fort Lauderdale, FL | $135.83 | $63.42 |
| Fort Worth, TX | $129.98 | $59.50 |
| Fresno, CA | $137.82 | $59.48 |
| Galveston, TX | $130.32 | $59.34 |
| Hanford, CA | $137.82 | $59.48 |
| Hawaii, Guam, HI | $140.56 | $59.29 |
| Houston, TX | $132.70 | $61.72 |
| Idaho | $122.48 | $56.72 |
| Indiana | $123.11 | $56.85 |
| Iowa | $121.75 | $56.35 |
| Kansas | $121.32 | $56.70 |
| Kentucky | $121.89 | $58.34 |
| King County, WA | $151.18 | $63.48 |
| Los Angeles, CA | $146.54 | $61.98 |
| Madera, CA | $137.82 | $59.48 |
| Manhattan, NY | $149.89 | $66.83 |
| Marin County, CA | $166.54 | $65.76 |
| Merced, CA | $137.82 | $59.48 |
| Metropolitan Boston, MA | $148.41 | $63.07 |
| Metropolitan Kansas City, MO | $126.21 | $59.10 |
| Metropolitan Philadelphia, PA | $136.25 | $61.85 |
| Metropolitan St. Louis, MO | $127.38 | $59.33 |
| Miami, FL | $141.23 | $66.82 |
| Minnesota | $130.56 | $57.01 |
| Mississippi | $118.85 | $57.31 |
| Modesto, CA | $137.82 | $59.48 |
| Montana | $131.26 | $59.78 |
| Napa, CA | $157.82 | $63.61 |
| Nebraska | $122.32 | $56.34 |
| Nevada | $130.62 | $59.07 |
| New Hampshire | $134.05 | $59.64 |
| New Mexico | $125.40 | $59.86 |
| New Orleans, LA | $127.07 | $59.81 |
| North Carolina | $124.26 | $57.57 |
| North Dakota | $128.69 | $57.21 |
| Northern New Jersey | $147.43 | $64.52 |
| NYC suburbs and Long Island, NY | $153.26 | $68.27 |
| Ohio | $124.24 | $58.98 |
| Oklahoma | $121.61 | $57.78 |
| Oxnard, CA | $145.68 | $61.19 |
| Portland, OR | $139.90 | $60.48 |
| Poughkeepsie and northern NYC suburbs, NY | $141.95 | $63.68 |
| Puerto Rico | $132.09 | $59.83 |
| Queens, NY | $150.89 | $66.40 |
| Redding, CA | $137.82 | $59.48 |
| Rest of California | $137.82 | $59.48 |
| Rest of Florida | $129.88 | $61.55 |
| Rest of Georgia | $123.33 | $59.58 |
| Rest of Illinois | $126.65 | $61.39 |
| Rest of Louisiana | $121.75 | $58.49 |
| Rest of Maine | $123.13 | $57.37 |
| Rest of Maryland | $132.34 | $60.01 |
| Rest of Massachusetts | $135.42 | $60.15 |
| Rest of Michigan | $124.76 | $59.51 |
| Rest of Missouri | $119.95 | $58.34 |
| Rest of New Jersey | $140.98 | $62.93 |
| Rest of New York | $125.92 | $58.01 |
| Rest of Oregon | $129.65 | $58.46 |
| Rest of Pennsylvania | $124.37 | $58.75 |
| Rest of Texas | $126.70 | $58.87 |
| Rest of Washington | $135.12 | $59.86 |
| Rhode Island | $134.34 | $60.51 |
| Riverside, CA | $139.24 | $60.90 |
| Sacramento, CA | $144.13 | $61.00 |
| Salinas, CA | $143.57 | $60.73 |
| San Benito County, CA | $170.16 | $67.09 |
| San Diego, CA | $146.56 | $61.07 |
| San Francisco, CA | $166.39 | $65.61 |
| San Luis Obispo, CA | $141.31 | $59.90 |
| Santa Clara County, CA | $169.56 | $66.48 |
| Santa Cruz, CA | $147.66 | $60.82 |
| Santa Maria, CA | $144.01 | $60.66 |
| Santa Rosa, CA | $149.13 | $61.35 |
| South Carolina | $124.45 | $58.40 |
| South Dakota | $128.38 | $56.90 |
| Southern Maine, ME | $128.93 | $58.10 |
| Stockton, CA | $137.82 | $59.48 |
| Suburban Chicago, IL | $137.13 | $63.72 |
| Tennessee | $121.87 | $56.90 |
| Utah | $125.95 | $58.76 |
| Vallejo, CA | $157.61 | $63.40 |
| Vermont | $128.31 | $57.55 |
| Virgin Islands, VI | $132.09 | $59.83 |
| Virginia | $128.61 | $58.35 |
| Visalia, CA | $137.82 | $59.48 |
| Washington, DC area | $148.67 | $64.47 |
| West Virginia | $122.50 | $60.39 |
| Wisconsin | $124.85 | $56.38 |
| Wyoming | $130.14 | $58.66 |
| Yuba City, CA | $137.82 | $59.48 |
31654 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$117.72
$157.47
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $157.47 | 1 |
| AL | $119.24 | 1 |
| AR | $117.72 | 1 |
| AZ | $128.12 | 1 |
| CA | $137.82–$170.16 | 29 |
| CO | $136.06 | 1 |
| CT | $139.34 | 1 |
| DC | $148.67 | 1 |
| DE | $130.08 | 1 |
| FL | $129.88–$141.23 | 3 |
| GA | $123.33–$133.57 | 2 |
| GU | $140.56 | 1 |
| HI | $140.56 | 1 |
| IA | $121.75 | 1 |
| ID | $122.48 | 1 |
| IL | $126.65–$137.61 | 4 |
| IN | $123.11 | 1 |
| KS | $121.32 | 1 |
| KY | $121.89 | 1 |
| LA | $121.75–$127.07 | 2 |
| MA | $135.42–$148.41 | 2 |
| MD | $132.34–$148.67 | 3 |
| ME | $123.13–$128.93 | 2 |
| MI | $124.76–$131.40 | 2 |
| MN | $130.56 | 1 |
| MO | $119.95–$127.38 | 3 |
| MS | $118.85 | 1 |
| MT | $131.26 | 1 |
| NC | $124.26 | 1 |
| ND | $128.69 | 1 |
| NE | $122.32 | 1 |
| NH | $134.05 | 1 |
| NJ | $140.98–$147.43 | 2 |
| NM | $125.40 | 1 |
| NV | $130.62 | 1 |
| NY | $125.92–$153.26 | 5 |
| OH | $124.24 | 1 |
| OK | $121.61 | 1 |
| OR | $129.65–$139.90 | 2 |
| PA | $124.37–$136.25 | 2 |
| PR | $132.09 | 1 |
| RI | $134.34 | 1 |
| SC | $124.45 | 1 |
| SD | $128.38 | 1 |
| TN | $121.87 | 1 |
| TX | $123.65–$135.57 | 8 |
| UT | $125.95 | 1 |
| VA | $128.61–$148.67 | 2 |
| VI | $132.09 | 1 |
| VT | $128.31 | 1 |
| WA | $135.12–$151.18 | 2 |
| WI | $124.85 | 1 |
| WV | $122.50 | 1 |
| WY | $130.14 | 1 |
How the 31654 rate is calculated
Each of 31654’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 · 31654
RVUs × geographic indexes × conversion factor
Work1.37
1.37 RVUs× 1.000 GPCI
Practice expense2.43
2.43 RVUs× 1.000 GPCI
Malpractice0.13
0.13 RVUs× 1.000 GPCI
Adjusted RVUs
3.9300
Conversion factor
$33.4009
Medicare rate
$131.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31654
The CMS indicators that decide how 31654 is paid alongside other services.
CMS payment indicators · 31654
Bronchoscopy guidance, peripheral lesion localization
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
31654 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 31628Lung biopsySingle lobe
- 31628 reports transbronchial lung biopsy; 31654 reports the additional EBUS guidance used to localize a peripheral lesion when that guidance is performed.
- 31629Bronchoscopic biopsyNeedle aspiration biopsy
- 31629 reports transbronchial needle aspiration. Add 31654 when EBUS is used to guide work on a peripheral lung lesion.
- 31652EBUS node samplingOne or two stations
- 31652 covers EBUS-guided sampling of one or two mediastinal or hilar nodes; 31654 concerns EBUS guidance for peripheral pulmonary lesions.
- 31653EBUS-guided samplingThree or more stations
- 31653 covers EBUS-guided sampling of three or more mediastinal or hilar nodes; it is not the peripheral-lesion guidance service represented by 31654.
31654 billing questions
When is 31654 appropriate instead of 31652 or 31653?
Use 31654 for EBUS guidance of a peripheral pulmonary lesion. Codes 31652 and 31653 describe EBUS-guided sampling of mediastinal or hilar lymph nodes.
Can 31654 be reported by itself?
No. It is an add-on code and must be reported with a primary bronchoscopy procedure, such as an appropriate biopsy or aspiration service.
Can 31654 be paired with 31628 or 31629?
It may be paired with 31628 for transbronchial lung biopsy or 31629 for transbronchial needle aspiration when that procedure is performed on the peripheral lesion.
What documentation supports reporting 31654?
Document the peripheral pulmonary target and the use of endobronchial ultrasound to locate or guide the bronchoscopic work on that lesion.
Is 31654 reported once for each lesion?
The code covers EBUS guidance for peripheral lesion(s). Do not assume a separate unit for each lesion from the code description alone.
How does the add-on status affect payment?
CMS pays 31654 within the global period of the primary procedure, and it cannot be billed as a standalone procedure.
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
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