Billing code 31625: Bronchoscopy biopsyMedicare rate & RVUs in Delaware
Reports bronchoscopic tissue sampling from an airway lesion or abnormal mucosa, such as when a pulmonologist biopsies a suspicious endobronchial finding.
Medicare pays $380.33 for 31625 in the office in Delaware (Delaware). Which amount applies depends on the service address.
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 9 sections
What 31625 covers
A pulmonologist or other qualified physician passes a bronchoscope into the airways and obtains tissue from an abnormal area, commonly with biopsy forceps. Typical targets include a visible bronchial mass, irregular mucosa, or another airway lesion requiring histologic evaluation. The procedure is commonly performed in a hospital bronchoscopy suite or an outpatient procedural setting, with sedation or anesthesia as clinically appropriate.
Choose this code for biopsy of airway tissue; transbronchial sampling of lung parenchyma is represented by a different code. The report should identify the biopsy site and describe the abnormality sampled and the tissue obtained. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed in the same session, endoscopy-family pricing applies. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, 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.
31625 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $380.33 | $139.76 |
How the 31625 rate is calculated
Each of 31625’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 · 31625
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.03Practice expense 8.17Malpractice 0.30
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 31625
The CMS indicators that decide how 31625 is paid alongside other services.
CMS payment indicators · 31625
Bronchoscopy 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
31625 without 51 · national office
$384.11
Bronchoscopy biopsy
31625-51 · Second procedure: 50%
$192.06
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%).
31625 compared with similar codes
Compare codes
31625 vs 31628 vs 31622 vs 31623 vs 31629: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 31628Lung biopsy
- The biopsy target determines the choice: 31625 is for airway tissue, while 31628 is for transbronchial lung tissue.
- 31622Bronchoscopy
- 31622 describes diagnostic bronchoscopy without the airway tissue biopsy reported with 31625.
- 31623Bronchoscopy
- 31623 collects cells by brushing; 31625 obtains tissue from an airway abnormality.
- 31629Bronchoscopic biopsy
- 31629 describes needle aspiration sampling, rather than the airway tissue biopsy reported with 31625.
31625 billing questions
When should this code be chosen instead of 31628?
Use this code for tissue taken from an airway lesion or mucosa. Code 31628 applies to transbronchial biopsy of lung tissue.
Can diagnostic bronchoscopy also be reported?
The airway inspection needed to locate and obtain the biopsy is part of the biopsy service. CMS endoscopy-family pricing applies when related endoscopies are performed together.
What documentation supports the biopsy?
Document the airway site, the abnormal finding sampled, and that tissue was obtained for evaluation. Distinguish an airway biopsy from sampling of lung parenchyma.
Should modifier 50 be appended for biopsies on both sides?
No. CMS identifies bilateral adjustment as inapplicable because the code descriptor or anatomy makes modifier 50 inappropriate.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
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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