Billing code 31628: Lung biopsyMedicare rate & RVUs
Report this bronchoscopy when transbronchial lung tissue is sampled from one lobe; use the companion add-on code for each additional lobe.
Medicare pays $408.49 for 31628 nationally in the office and $158.65 in a hospital or facility. Local office rates run $363.40–$540.69.
Medicare rate · 31628
Lung biopsy
Swap in your local Medicare rate.
- Work RVUs
- 3.46
- Total RVUs
- 12.23
- Global days
- 000
National rate · 2026
$408.49
Office setting, before claim adjustments.
See every locality for 31628 → · 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.
On this page 10 sections
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.
Where 31628 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
$363.40 to $540.69
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $368.47 | $149.86 |
| Alaska* | $479.65 | $213.57 |
| Arizona | $398.17 | $156.07 |
| Arkansas | $363.40 | $148.79 |
| Atlanta | $415.57 | $161.73 |
| Austin | $423.82 | $159.49 |
| Bakersfield | $433.44 | $159.62 |
| Baltimore/Surr. Cntys | $433.53 | $165.46 |
| Beaumont | $382.34 | $154.99 |
| Brazoria | $404.46 | $156.87 |
| Chicago | $424.99 | $173.90 |
| Chico | $432.41 | $158.58 |
| Colorado | $425.51 | $159.68 |
| Connecticut | $434.83 | $165.75 |
| Dallas | $406.84 | $158.00 |
| Dc + Md/Va Suburbs | $466.16 | $171.85 |
| Delaware | $404.57 | $157.73 |
| Detroit | $406.19 | $165.09 |
| East St. Louis | $397.12 | $167.27 |
| El Centro | $432.46 | $158.64 |
| Fort Lauderdale | $421.06 | $167.98 |
| Fort Worth | $404.16 | $157.82 |
| Fresno | $432.41 | $158.58 |
| Galveston | $405.55 | $157.46 |
| Hanford-Corcoran | $432.41 | $158.58 |
| Hawaii, Guam | $442.47 | $158.41 |
| Houston | $411.59 | $163.50 |
| Idaho | $380.13 | $150.28 |
| Indiana | $382.25 | $150.65 |
| Iowa | $377.88 | $149.28 |
| Kansas | $375.96 | $150.11 |
| Kentucky | $376.26 | $154.16 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $461.12 | $165.56 |
| Madera | $432.41 | $158.58 |
| Manhattan | $468.02 | $177.70 |
| Merced | $432.41 | $158.58 |
| Metropolitan Boston | $466.71 | $168.40 |
| Metropolitan Kansas City | $391.04 | $156.44 |
| Metropolitan Philadelphia | $424.26 | $164.18 |
| Metropolitan St. Louis | $394.98 | $157.14 |
| Miami | $436.90 | $176.82 |
| Minnesota | $408.91 | $151.82 |
| Mississippi | $366.43 | $151.32 |
| Modesto | $432.41 | $158.58 |
| Montana** | $408.47 | $158.63 |
| Napa | $500.00 | $170.71 |
| Nebraska | $379.93 | $149.33 |
| Nevada** | $406.93 | $156.85 |
| New Hampshire | $418.67 | $158.59 |
| New Mexico | $387.31 | $158.21 |
| New Orleans | $393.36 | $158.26 |
| North Carolina | $385.63 | $152.53 |
| North Dakota** | $401.95 | $152.11 |
| Northern Nj | $461.63 | $171.81 |
| Nyc Suburbs/Long Island | $478.62 | $181.56 |
| Ohio | $384.06 | $155.95 |
| Oklahoma | $375.87 | $152.77 |
| Oxnard-Thousand Oaks-Ventura | $458.88 | $163.57 |
| Portland | $438.81 | $161.24 |
| Poughkpsie/N Nyc Suburbs | $442.79 | $169.22 |
| Puerto Rico | $411.43 | $158.84 |
| Queens | $472.07 | $176.76 |
| Redding | $432.41 | $158.58 |
| Rest Of California | $432.41 | $158.58 |
| Rest Of Florida | $401.63 | $162.79 |
| Rest Of Georgia | $380.16 | $157.31 |
| Rest Of Illinois | $390.17 | $162.07 |
| Rest Of Louisiana | $375.61 | $154.50 |
| Rest Of Maine | $381.77 | $151.92 |
| Rest Of Maryland | $412.13 | $159.29 |
| Rest Of Massachusetts | $423.05 | $159.97 |
| Rest Of Michigan | $385.39 | $157.29 |
| Rest Of Missouri | $369.30 | $153.94 |
| Rest Of New Jersey | $440.12 | $167.30 |
| Rest Of New York | $391.12 | $153.78 |
| Rest Of Oregon | $404.09 | $155.25 |
| Rest Of Pennsylvania | $384.77 | $155.42 |
| Rest Of Texas | $393.05 | $155.95 |
| Rest Of Washington | $422.30 | $159.22 |
| Rhode Island | $418.80 | $160.72 |
| Riverside-San Bernardino-Ontario | $436.02 | $162.19 |
| Sacramento-Roseville-Folsom | $453.49 | $162.93 |
| Salinas | $451.78 | $162.22 |
| San Diego-Chula Vista-Carlsbad | $462.16 | $163.36 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $529.09 | $176.82 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $528.71 | $176.44 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $540.69 | $180.42 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $539.16 | $178.89 |
| San Luis Obispo-Paso Robles | $444.53 | $159.96 |
| Santa Cruz-Watsonville | $466.41 | $162.86 |
| Santa Maria-Santa Barbara | $453.41 | $162.10 |
| Santa Rosa-Petaluma | $471.12 | $164.32 |
| Seattle (King Cnty) | $476.25 | $169.69 |
| South Carolina | $385.41 | $154.56 |
| South Dakota** | $401.17 | $151.34 |
| Southern Maine | $401.89 | $154.30 |
| Stockton | $432.41 | $158.58 |
| Suburban Chicago | $425.42 | $168.84 |
| Tennessee | $377.74 | $150.63 |
| Utah | $390.45 | $155.61 |
| Vallejo | $499.46 | $170.17 |
| Vermont | $400.23 | $152.89 |
| Virgin Islands | $411.43 | $158.84 |
| Virginia | $400.46 | $154.87 |
| Visalia | $432.41 | $158.58 |
| West Virginia | $376.31 | $159.20 |
| Wisconsin | $389.03 | $149.68 |
| Wyoming** | $405.63 | $155.79 |
| Yuba City | $432.41 | $158.58 |
31628 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.
$363.40
$486.55
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 | $479.65 | 1 |
| AL | $368.47 | 1 |
| AR | $363.40 | 1 |
| AZ | $398.17 | 1 |
| CA | $432.41–$540.69 | 29 |
| CO | $425.51 | 1 |
| CT | $434.83 | 1 |
| DC | $466.16 | 1 |
| DE | $404.57 | 1 |
| FL | $401.63–$436.90 | 3 |
| GA | $380.16–$415.57 | 2 |
| GU | $442.47 | 1 |
| HI | $442.47 | 1 |
| IA | $377.88 | 1 |
| ID | $380.13 | 1 |
| IL | $390.17–$425.42 | 4 |
| IN | $382.25 | 1 |
| KS | $375.96 | 1 |
| KY | $376.26 | 1 |
| LA | $375.61–$393.36 | 2 |
| MA | $423.05–$466.71 | 2 |
| MD | $412.13–$466.16 | 3 |
| ME | $381.77–$401.89 | 2 |
| MI | $385.39–$406.19 | 2 |
| MN | $408.91 | 1 |
| MO | $369.30–$394.98 | 3 |
| MS | $366.43 | 1 |
| MT | $408.47 | 1 |
| NC | $385.63 | 1 |
| ND | $401.95 | 1 |
| NE | $379.93 | 1 |
| NH | $418.67 | 1 |
| NJ | $440.12–$461.63 | 2 |
| NM | $387.31 | 1 |
| NV | $406.93 | 1 |
| NY | $391.12–$478.62 | 5 |
| OH | $384.06 | 1 |
| OK | $375.87 | 1 |
| OR | $404.09–$438.81 | 2 |
| PA | $384.77–$424.26 | 2 |
| PR | $411.43 | 1 |
| RI | $418.80 | 1 |
| SC | $385.41 | 1 |
| SD | $401.17 | 1 |
| TN | $377.74 | 1 |
| TX | $382.34–$423.82 | 8 |
| UT | $390.45 | 1 |
| VA | $400.46–$466.16 | 2 |
| VI | $411.43 | 1 |
| VT | $400.23 | 1 |
| WA | $422.30–$476.25 | 2 |
| WI | $389.03 | 1 |
| WV | $376.31 | 1 |
| WY | $405.63 | 1 |
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
Swap in your local Medicare rate.
Work 3.46Practice expense 8.44Malpractice 0.33
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 31628
The CMS indicators that decide how 31628 is paid alongside other services.
CMS payment indicators · 31628
Lung biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
31628 without 51 · national office
$408.49
Lung biopsy
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%).
31628 compared with similar codes
Compare codes
31628 vs 31625 vs 31629 vs 31632: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 31625Bronchoscopy biopsy
- Use 31628 for transbronchial sampling of lung tissue. Use 31625 when the biopsy target is an endobronchial site.
- 31629Bronchoscopic biopsy
- 31629 is for transbronchial needle biopsy or aspiration. This code is for transbronchial lung tissue biopsy using a different sampling method.
- 31632Lung biopsy
- 31628 covers the first lobe sampled; 31632 reports each additional lobe sampled during the session.
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
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