CPT code 31654: Bronchoscopy guidance, peripheral lesion localization2026 Medicare rate & RVUs in Puerto Rico
Add-on bronchoscopy guidance using endobronchial ultrasound to localize peripheral pulmonary lesions during a separately reported bronchoscopic procedure, commonly for tissue sampling.
In Puerto Rico, Medicare pays $132.09 for 31654 in the office and $59.83 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 31654 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How Puerto Rico compares for 31654
Across 109 of 109 payment localities, the office rate for 31654 runs from $117.72 in Arkansas to $170.16 in San Benito County, CA. Puerto Rico pays $132.09. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$132.09
- Los Angeles, CA · California$146.54+$14.45
- Washington, DC area · District of Columbia$148.67+$16.58
- Miami, FL · Florida$141.23+$9.14
- Chicago, IL · Illinois$137.61+$5.52
- Manhattan, NY · New York$149.89+$17.80
- Alaska · Alaska$157.47+$25.38
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $119.24 | $56.69 |
| ArkansasArkansas | $117.72 | $56.32 |
| ArizonaArizona | $128.12 | $58.86 |
| Bakersfield, CACalifornia | $138.23 | $59.89 |
| Chico, CACalifornia | $137.82 | $59.48 |
| El Centro, CACalifornia | $137.84 | $59.50 |
| Fresno, CACalifornia | $137.82 | $59.48 |
| Hanford, CACalifornia | $137.82 | $59.48 |
| Madera, CACalifornia | $137.82 | $59.48 |
| Merced, CACalifornia | $137.82 | $59.48 |
| Modesto, CACalifornia | $137.82 | $59.48 |
| Napa, CACalifornia | $157.82 | $63.61 |
| Oxnard, CACalifornia | $145.68 | $61.19 |
| Redding, CACalifornia | $137.82 | $59.48 |
| Rest of CaliforniaCalifornia | $137.82 | $59.48 |
| Riverside, CACalifornia | $139.24 | $60.90 |
| Sacramento, CACalifornia | $144.13 | $61.00 |
| Salinas, CACalifornia | $143.57 | $60.73 |
| San Diego, CACalifornia | $146.56 | $61.07 |
| Marin County, CACalifornia | $166.54 | $65.76 |
| San Francisco, CACalifornia | $166.39 | $65.61 |
| San Benito County, CACalifornia | $170.16 | $67.09 |
| Santa Clara County, CACalifornia | $169.56 | $66.48 |
| San Luis Obispo, CACalifornia | $141.31 | $59.90 |
| Santa Cruz, CACalifornia | $147.66 | $60.82 |
| Santa Maria, CACalifornia | $144.01 | $60.66 |
| Santa Rosa, CACalifornia | $149.13 | $61.35 |
| Stockton, CACalifornia | $137.82 | $59.48 |
| Vallejo, CACalifornia | $157.61 | $63.40 |
| Visalia, CACalifornia | $137.82 | $59.48 |
| Yuba City, CACalifornia | $137.82 | $59.48 |
| ColoradoColorado | $136.06 | $60.01 |
| ConnecticutConnecticut | $139.34 | $62.36 |
| DelawareDelaware | $130.08 | $59.46 |
| Fort Lauderdale, FLFlorida | $135.83 | $63.42 |
| Rest of FloridaFlorida | $129.88 | $61.55 |
| Atlanta, GAGeorgia | $133.57 | $60.95 |
| Rest of GeorgiaGeorgia | $123.33 | $59.58 |
| Hawaii, Guam, HIHawaii | $140.56 | $59.29 |
| IowaIowa | $121.75 | $56.35 |
| IdahoIdaho | $122.48 | $56.72 |
| East St. Louis, ILIllinois | $129.18 | $63.42 |
| Rest of IllinoisIllinois | $126.65 | $61.39 |
| Suburban Chicago, ILIllinois | $137.13 | $63.72 |
| IndianaIndiana | $123.11 | $56.85 |
| KansasKansas | $121.32 | $56.70 |
| KentuckyKentucky | $121.89 | $58.34 |
| New Orleans, LALouisiana | $127.07 | $59.81 |
| Rest of LouisianaLouisiana | $121.75 | $58.49 |
| Metropolitan Boston, MAMassachusetts | $148.41 | $63.07 |
| Rest of MassachusettsMassachusetts | $135.42 | $60.15 |
| Baltimore area, MDMaryland | $138.95 | $62.26 |
| Rest of MarylandMaryland | $132.34 | $60.01 |
| Rest of MaineMaine | $123.13 | $57.37 |
| Southern Maine, MEMaine | $128.93 | $58.10 |
| Detroit, MIMichigan | $131.40 | $62.43 |
| Rest of MichiganMichigan | $124.76 | $59.51 |
| MinnesotaMinnesota | $130.56 | $57.01 |
| Metropolitan Kansas City, MOMissouri | $126.21 | $59.10 |
| Metropolitan St. Louis, MOMissouri | $127.38 | $59.33 |
| Rest of MissouriMissouri | $119.95 | $58.34 |
| MississippiMississippi | $118.85 | $57.31 |
| MontanaMontana | $131.26 | $59.78 |
| North CarolinaNorth Carolina | $124.26 | $57.57 |
| North DakotaNorth Dakota | $128.69 | $57.21 |
| NebraskaNebraska | $122.32 | $56.34 |
| New HampshireNew Hampshire | $134.05 | $59.64 |
| Northern New JerseyNew Jersey | $147.43 | $64.52 |
| Rest of New JerseyNew Jersey | $140.98 | $62.93 |
| New MexicoNew Mexico | $125.40 | $59.86 |
| NevadaNevada | $130.62 | $59.07 |
| NYC suburbs and Long Island, NYNew York | $153.26 | $68.27 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $141.95 | $63.68 |
| Queens, NYNew York | $150.89 | $66.40 |
| Rest of New YorkNew York | $125.92 | $58.01 |
| OhioOhio | $124.24 | $58.98 |
| OklahomaOklahoma | $121.61 | $57.78 |
| Portland, OROregon | $139.90 | $60.48 |
| Rest of OregonOregon | $129.65 | $58.46 |
| Metropolitan Philadelphia, PAPennsylvania | $136.25 | $61.85 |
| Rest of PennsylvaniaPennsylvania | $124.37 | $58.75 |
| Rhode IslandRhode Island | $134.34 | $60.51 |
| South CarolinaSouth Carolina | $124.45 | $58.40 |
| South DakotaSouth Dakota | $128.38 | $56.90 |
| TennesseeTennessee | $121.87 | $56.90 |
| Austin, TXTexas | $135.57 | $59.95 |
| Beaumont, TXTexas | $123.65 | $58.61 |
| Brazoria, TXTexas | $129.95 | $59.11 |
| Dallas, TXTexas | $130.74 | $59.54 |
| Fort Worth, TXTexas | $129.98 | $59.50 |
| Galveston, TXTexas | $130.32 | $59.34 |
| Houston, TXTexas | $132.70 | $61.72 |
| Rest of TexasTexas | $126.70 | $58.87 |
| UtahUtah | $125.95 | $58.76 |
| VirginiaVirginia | $128.61 | $58.35 |
| Virgin Islands, VIUnited States Virgin Islands | $132.09 | $59.83 |
| VermontVermont | $128.31 | $57.55 |
| Rest of WashingtonWashington | $135.12 | $59.86 |
| King County, WAWashington | $151.18 | $63.48 |
| WisconsinWisconsin | $124.85 | $56.38 |
| West VirginiaWest Virginia | $122.50 | $60.39 |
| WyomingWyoming | $130.14 | $58.66 |
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.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
3,659
- Code
- 31654
- Physician work
- 1.37
- Practice expense
- 2.43
- Malpractice
- 0.13
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.37 | × 1.000 | 1.3700 |
| Practice expense | 2.43 | × 1.011 | 2.4567 |
| Malpractice | 0.13 | × 0.985 | 0.1280 |
| Total RVUs | 3.9548 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$132.09
Office: (1.37 × 1 + 2.43 × 1.011 + 0.13 × 0.985) × $33.4009 = $132.09
Facility: (1.37 × 1 + 0.29 × 1.011 + 0.13 × 0.985) × $33.4009 = $59.83
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. |
How 31654 has changed in Puerto Rico
31654 · Office / nonfacility
$132.09
Effective 2026-10-01
The base rate is $16.23 higher than on 2025-10-01, moving from $115.86 to $132.09 (14.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$115.86changed to$132.09
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.40 changed to 1.37
- Practice expense RVU 2.04 changed to 2.43
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$120.24changed to$115.86
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.07 changed to 2.04
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$118.28changed to$120.24
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$121.81changed to$118.28
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.06 changed to 2.07
- Malpractice RVU 0.12 changed to 0.13
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$121.32changed to$121.81
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$126.15changed to$121.32
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 2.12 changed to 2.06
- Malpractice RVU 0.11 changed to 0.12
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$127.20changed to$126.15
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$126.11changed to$127.20
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.97 changed to 2.12
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$127.68changed to$126.11
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 2.01 changed to 1.97
- Malpractice RVU 0.12 changed to 0.11
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$129.35changed to$127.68
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.06 changed to 2.01
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$116.52changed to$129.35
- Conversion factor 35.8887 changed to 35.9996
- Malpractice RVU 0.13 changed to 0.12
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$116.36changed to$116.52
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 2.57 changed to 2.06
- Practice expense GPCI 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
No ratechanged to$116.36
Held through RVU16B, RVU16C, RVU16D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $132.09 | $59.83 | RVU26D |
| 2026-07-01 | $132.09 | $59.83 | RVU26C |
| 2026-04-01 | $132.09 | $59.83 | RVU26B |
| 2026-01-01 | $132.09 | $59.83 | RVU26A |
| 2025-10-01 | $115.86 | $63.42 | RVU25D |
| 2025-07-01 | $115.86 | $63.42 | RVU25C |
| 2025-04-01 | $115.86 | $63.42 | RVU25B |
| 2025-01-01 | $115.86 | $63.42 | RVU25A |
| 2024-10-01 | $120.24 | $65.27 | RVU24D |
| 2024-07-01 | $120.24 | $65.27 | RVU24C |
| 2024-04-01 | $120.24 | $65.27 | RVU24B |
| 2024-03-09 | $120.24 | $65.27 | RVU24AR |
| 2024-01-01 | $118.28 | $64.20 | RVU24A |
| 2023-10-01 | $121.81 | $65.79 | RVU23D |
| 2023-07-01 | $121.32 | $65.74 | RVU23C |
| 2023-04-01 | $121.32 | $65.74 | RVU23B |
| 2023-01-01 | $121.32 | $65.74 | RVU23A |
| 2022-10-01 | $126.15 | $67.55 | RVU22D |
| 2022-07-01 | $126.15 | $67.55 | RVU22C |
| 2022-04-01 | $126.15 | $67.55 | RVU22B |
| 2022-01-01 | $126.15 | $67.55 | RVU22A |
| 2021-10-01 | $127.20 | $68.11 | RVU21D |
| 2021-07-01 | $127.20 | $68.11 | RVU21C |
| 2021-04-01 | $127.20 | $68.11 | RVU21B |
| 2021-01-01 | $127.20 | $68.11 | RVU21A |
| 2020-10-01 | $126.11 | $70.09 | RVU20D |
| 2020-07-01 | $126.11 | $70.09 | RVU20C |
| 2020-04-01 | $126.11 | $70.09 | RVU20B |
| 2020-01-01 | $126.11 | $70.09 | RVU20A |
| 2019-10-01 | $127.68 | $69.98 | RVU19D |
| 2019-07-01 | $127.68 | $69.98 | RVU19C |
| 2019-04-01 | $127.68 | $69.98 | RVU19B |
| 2019-01-01 | $127.68 | $69.98 | RVU19A |
| 2018-10-01 | $129.35 | $70.26 | RVU18D |
| 2018-07-01 | $129.35 | $70.26 | RVU18C |
| 2018-04-01 | $129.35 | $70.26 | RVU18B |
| 2018-01-01 | $129.35 | $70.26 | RVU18AR1 |
| 2017-10-01 | $116.52 | $66.45 | RVU17D |
| 2017-07-01 | $116.52 | $66.45 | RVU17C |
| 2017-04-01 | $116.52 | $66.45 | RVU17B |
| 2017-01-01 | $116.52 | $66.45 | RVU17A |
| 2016-10-01 | $116.36 | $62.09 | RVU16D |
| 2016-07-01 | $116.36 | $62.09 | RVU16C |
| 2016-04-01 | $116.36 | $62.09 | RVU16B |
| 2016-01-01 | $116.36 | $62.09 | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
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
Show the CMS file lines behind this rate
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