CPT 31628
Global 000 ActiveBronchoscopy/lung bx each
CPT 31628 Billing & Documentation Guide
CPT code 31628 (Bronchoscopy/lung bx each) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.46, a non-facility practice expense RVU of 8.44, and a malpractice RVU of 0.33, a total non-facility RVU of 12.23 and facility RVU of 4.75. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $421.57, though rates vary from $363.4 to $540.69 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 31628, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 31628 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 31628 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 31628
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.46 | 3.46 |
| Practice Expense RVU | 8.44 | 0.96 |
| Malpractice RVU | 0.33 | 0.33 |
| Total RVU | 12.23 | 4.75 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 31628
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $459.26 | $163.63 | $432.41 - $540.69 | 29 |
| Florida | $419.86 | $169.2 | $401.63 - $436.9 | 3 |
| Georgia | $397.87 | $159.52 | $380.16 - $415.57 | 2 |
| Illinois | $409.43 | $168.02 | $390.17 - $425.42 | 4 |
| Michigan | $395.79 | $161.19 | $385.39 - $406.19 | 2 |
| North Carolina | $385.63 | $152.53 | $385.63 - $385.63 | 1 |
| New York | $450.52 | $171.8 | $391.12 - $478.62 | 5 |
| Ohio | $384.06 | $155.95 | $384.06 - $384.06 | 1 |
| Pennsylvania | $404.52 | $159.8 | $384.77 - $424.26 | 2 |
| Texas | $403.98 | $158.01 | $382.34 - $423.82 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 31628
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 31628 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00520 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0251T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0253T | Column 1 (primary), can be billed with modifier | 9 | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 31628
What does CPT code 31628 mean? +
CPT code 31628 represents: Bronchoscopy/lung bx each. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 000.
What is the Medicare reimbursement for CPT 31628? +
The 2026 Medicare national average non-facility payment for CPT 31628 is $421.57. Rates range from $363.4 to $540.69 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 31628? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 31628? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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