$358.49–$377.96
Use 31628 for transbronchial sampling of lung tissue. Use 31625 when the biopsy target is an endobronchial site.
On this page
CMS RVU26D · Effective 2026-10-01
31628 Lung biopsy Medicare reimbursement rates in Maine
Report this bronchoscopy when transbronchial lung tissue is sampled from one lobe; use the companion add-on code for each additional lobe. Compare 31628 office and facility rates across CMS payment localities in Maine.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 31628 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$381.77–$401.89
2 of 2 localities have a supported rate.
Facility setting
$151.92–$154.30
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Pulmonary endoscopy
About 31628: Transbronchial lung biopsy, one lobe
Report this bronchoscopy when transbronchial lung tissue is sampled from one lobe; use the companion add-on code for each additional lobe.
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.
CMS billing rules for 31628
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.46 · 28%
- Practice expense (office) RVU8.44 · 69%
- Malpractice RVU0.33 · 3%
43.3K
Medicare services in 2024 · #835 by national volume
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.
31628 compared with similar codes
Office rates for Maine, from the same CMS release.
$463.44–$489.30
31629 is for transbronchial needle biopsy or aspiration. This code is for transbronchial lung tissue biopsy using a different sampling method.
$65.18–$67.53
31628 covers the first lobe sampled; 31632 reports each additional lobe sampled during the session.
Compare 31628 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
$381.77
Facility
$151.92
Southern Maine →
Office / nonfacility
$401.89
Facility
$154.30
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,63431625,,Bronchoscopy w/biopsy(s),A,,3.03,8.17,,0.88,,0.30,11.50,4.21,0,000,0.00,0.00,0.00,3,0,1,0,0,9,31622,33.4009,09,0,99,0.00,0.00,0.00
3,63531626,,Bronchoscopy w/markers,A,,3.81,21.78,,1.08,,0.44,26.03,5.33,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,63631627,,Navigational bronchoscopy,A,,1.95,32.44,,0.40,,0.20,34.59,2.55,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,63731628,,Bronchoscopy/lung bx each,A,,3.46,8.44,,0.96,,0.33,12.23,4.75,0,000,0.00,0.00,0.00,3,0,1,0,0,9,31622,33.4009,09,0,99,0.00,0.00,0.00
3,63831629,,Bronchoscopy/needle bx each,A,,3.66,10.86,,1.02,,0.36,14.88,5.04,0,000,0.00,0.00,0.00,3,0,1,0,0,9,31622,33.4009,09,0,99,0.00,0.00,0.00
3,63931630,,Bronchoscopy dilate/fx repr,A,,3.71,1.14,NA,1.14,,0.44,5.29,5.29,0,000,0.00,0.00,0.00,3,0,1,0,0,9,31622,33.4009,09,0,99,0.00,0.00,0.00
3,64031631,,Bronchoscopy dilate w/stent,A,,4.25,1.25,NA,1.25,,0.48,5.98,5.98,0,000,0.00,0.00,0.00,3,0,1,0,0,9,31622,33.4009,09,0,99,0.00,0.00,0.00