Billing code 31653: EBUS-guided samplingMedicare rate & RVUs in Washington
Reports bronchoscopic EBUS-guided needle sampling of three or more mediastinal or hilar lymph node stations or structures, commonly for lung cancer staging.
Medicare pays $1,462.27–$1,681.72 for 31653 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 31653 covers
A pulmonologist or thoracic surgeon uses a bronchoscope with endobronchial ultrasound to visualize central chest lymph nodes or structures and guide needle sampling. The service is commonly performed to evaluate mediastinal or hilar adenopathy or stage lung cancer, often during a hospital or outpatient bronchoscopy. The code covers sampling at three or more distinct mediastinal and/or hilar stations or structures; repeated needle passes at one station do not by themselves establish the three-station threshold.
Report the code when the procedure documentation identifies at least three sampled stations or structures and supports EBUS-guided transbronchial needle aspiration. Use the one-to-two-station code when fewer stations are sampled. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Medicare does not pay an assistant at surgery for this service; 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 31653 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $1,462.27 | $219.67 |
| Seattle (King Cnty) | $1,681.72 | $233.80 |
How the 31653 rate is calculated
Each of 31653’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 · 31653
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.84Practice expense 36.58Malpractice 0.47
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 31653
The CMS indicators that decide how 31653 is paid alongside other services.
CMS payment indicators · 31653
EBUS-guided sampling
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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
31653 without 51 · national office
$1,399.16
EBUS-guided sampling
31653-51 · Second procedure: 50%
$699.58
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%).
31653 compared with similar codes
Compare codes
31653 vs 31652 vs 31629 vs 31654 vs 31628: national Medicare rates
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How to choose
- 31652EBUS node sampling
- Choose 31652 when EBUS-guided needle sampling covers one or two mediastinal or hilar stations or structures; choose this code for three or more.
- 31629Bronchoscopic biopsy
- 31629 describes bronchoscopic transbronchial needle aspiration. This code captures EBUS-guided sampling of three or more mediastinal or hilar stations or structures.
- 31654Bronchoscopy guidance
- 31654 addresses EBUS evaluation of peripheral lung lesions. This code is for EBUS-guided sampling of central mediastinal or hilar stations or structures.
- 31628Lung biopsy
- 31628 is used for transbronchial lung tissue biopsy, whereas this code concerns EBUS-guided needle sampling of multiple mediastinal or hilar stations or structures.
31653 billing questions
How does this differ from the one-to-two-station EBUS code?
This code is selected when EBUS-guided needle sampling covers three or more distinct mediastinal or hilar stations or structures. Use the sibling code for sampling one or two.
Do multiple needle passes at one station count as multiple stations?
No. The threshold is based on the number of distinct stations or structures sampled, not the number of passes.
What should the procedure note identify?
Document EBUS-guided needle sampling and identify each mediastinal or hilar station or structure sampled. The documented targets should support a count of three or more.
Is sampling a peripheral lung lesion reported with this code?
This code describes sampling central mediastinal or hilar nodes or structures. EBUS evaluation of a peripheral lesion is addressed by a different code, and separate reporting depends on the services performed.
How is this code affected when other procedures occur in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Same-day preoperative and postoperative care is included in this code's 0-day global period.
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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