How much does Medicare pay for CPT 31625?

Medicare allowed an average of $72.30 per service and paid $57.05 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $855.95, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 31625?

Biopsy of lung airway using an endoscope. It was billed 2,869 times to 2,732 Medicare beneficiaries by 155 providers in 2024.

Which specialty bills 31625 most?

Pulmonary Disease, with 2,113 services from 114 clinicians. Next are Critical Care (Intensivists), Internal Medicine, Thoracic Surgery.

CPT 31625

Biopsy of lung airway using an endoscope

$72.30Medicare-allowed amount per service, averaged across 2,869 services

Providers submitted

$855.95

Asking price, not received

Medicare allowed

$72.30

The fee schedule figure

Medicare paid

$57.05

Balance is patient coinsurance

Providers submitted an average of $855.95 for this code and Medicare allowed $72.30 — 11.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $57.05 (79%); the rest is the patient’s coinsurance and deductible.

Services: 2,869
Beneficiaries: 2,732
Providers billing it: 155
Total allowed: $207,429

What Medicare pays for CPT 31625

Across 2,869 services billed by 155 providers to 2,732 beneficiaries, Medicare allowed an average of $72.30 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 31625

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	2,113	2,004	$74.55	114
Critical Care (Intensivists)	324	313	$56.85	18
Internal Medicine	206	198	$82.15	11
Thoracic Surgery	158	153	$59.35	8
General Surgery	46	43	$92.27	3
Hospitalist	22	21	$42.43	1

31625 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	376	$57.18	$38.99	18
Florida	232	$88.58	$63.57	14
Texas	193	$81.92	$61.97	10
Colorado	177	$106.42	$77.58	4
Illinois	166	$81.61	$59.21	9
North Carolina	162	$79.64	$64.70	10
New York	139	$90.96	$58.19	8
Pennsylvania	135	$38.80	$24.83	6
Virginia	117	$70.66	$49.74	6
Maryland	105	$44.30	$29.04	5
Tennessee	72	$42.20	$32.68	3
New Jersey	71	$68.68	$46.49	3
South Carolina	68	$39.03	$25.38	5
Michigan	59	$102.93	$78.33	4
Washington	59	$56.23	$41.17	3
District of Columbia	54	$63.09	$44.82	3
Missouri	53	$97.01	$75.66	4
Ohio	48	$71.40	$53.49	3
Mississippi	43	$78.52	$60.69	3
Indiana	41	$57.89	$45.35	3
Kentucky	39	$73.62	$54.30	3
Wisconsin	38	$67.81	$52.12	3
Alabama	37	$38.45	$28.94	2
Delaware	33	$48.19	$35.89	2
Alaska	32	$48.66	$21.40	1
Arkansas	31	$107.61	$92.13	2
Georgia	31	$84.01	$61.31	2
Iowa	30	$71.05	$58.38	2
Massachusetts	25	$97.32	$70.28	2
West Virginia	24	$134.32	$111.49	1
Arizona	23	$102.56	$74.94	2
Oklahoma	22	$42.43	$28.17	1
Utah	22	$99.39	$76.67	1
New Hampshire	21	$86.27	$62.42	1
South Dakota	19	$23.12	$17.32	1
North Dakota	18	$21.05	$8.99	1
Connecticut	15	$75.98	$53.50	1
Nebraska	14	$73.01	$60.89	1
Kansas	13	$76.55	$57.82	1
Vermont	12	$64.45	$49.10	1

Related codes

31624Irrigation and suction of lung airways to obtain cells$57.02
31628Biopsy of lobe of lung$77.25
31627Computer-assisted image-guided navigation of lung airways$93.76
31629Needle biopsy of windpipe cartilage$144.37
31645Aspiration of initial secretion of lung airway$83.67
31654Exam of lung airways$64.48
31652Exam of lung airways and sampling of lymph nodes$173.21
31653Exam of lung airways and sampling of lymph nodes$221.80
31622Diagnostic exam of lung airway$108.89
31615Exam of windpipe and lung airways through permanent windpipe opening$145.91
31623Exam of lung airways$15.29
31632Biopsy of lobe of lung$47.23

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.