How much does Medicare pay for CPT 31628?

Medicare allowed an average of $77.25 per service and paid $61.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1060.51, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 31628?

Biopsy of lobe of lung using an endoscope, 1 lobe. It was billed 32,767 times to 31,471 Medicare beneficiaries by 1,079 providers in 2024.

Does 31628 pay differently in an office than a hospital?

Yes. The allowed amount averaged $56.73 in an office setting and $77.40 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 31628 most?

Pulmonary Disease, with 24,956 services from 828 clinicians. Next are Critical Care (Intensivists), Internal Medicine, Thoracic Surgery.

CPT 31628

Biopsy of lobe of lung using an endoscope, 1 lobe

$77.25Medicare-allowed amount per service, averaged across 32,767 services

Providers submitted

$1060.51

Asking price, not received

Medicare allowed

$77.25

The fee schedule figure

Medicare paid

$61.17

Balance is patient coinsurance

Providers submitted an average of $1060.51 for this code and Medicare allowed $77.25 — 13.7× 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 $61.17 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $56.73
Hospital / facility: $77.40

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 244 services were billed in an office setting and 32,523 in a facility.

Services: 32,767
Beneficiaries: 31,471
Providers billing it: 1,079
Total allowed: $2,531,251

What Medicare pays for CPT 31628

Across 32,767 services billed by 1,079 providers to 31,471 beneficiaries, Medicare allowed an average of $77.25 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 31628

Specialty	Services	Beneficiaries	Avg allowed	Providers
Pulmonary Disease	24,956	23,922	$78.35	828
Critical Care (Intensivists)	4,018	3,876	$68.92	120
Internal Medicine	2,576	2,491	$72.67	80
Thoracic Surgery	778	761	$69.15	36
Cardiac Surgery	165	159	$41.98	5
Undefined Physician type	80	79	$87.16	1
Hospitalist	71	66	$124.20	4
Diagnostic Radiology	48	43	$166.37	1
Ambulatory Surgical Center	28	28	$846.59	1
Nurse Practitioner	17	16	$37.23	1
Allergy/ Immunology	16	16	$62.75	1
General Practice	14	14	$134.55	1

31628 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	3,119	$85.31	$53.03	86
Florida	2,852	$68.47	$45.88	90
Illinois	2,184	$78.58	$53.10	62
Texas	2,011	$80.95	$55.01	80
Pennsylvania	1,554	$80.18	$55.90	52
New York	1,535	$108.92	$69.21	50
Tennessee	1,522	$62.22	$42.14	46
Arizona	1,292	$106.66	$80.53	28
North Carolina	1,257	$68.21	$47.60	39
Ohio	1,180	$81.15	$59.42	43
Indiana	966	$59.66	$38.65	33
Massachusetts	948	$81.93	$53.53	26
Georgia	924	$61.49	$39.78	32
Kentucky	793	$61.79	$37.12	29
Maryland	790	$78.65	$54.19	20
Wisconsin	742	$107.38	$81.07	28
Virginia	698	$75.20	$44.38	27
Missouri	638	$68.79	$46.34	25
South Carolina	606	$63.21	$40.42	23
New Jersey	559	$89.78	$57.86	23
Michigan	556	$71.89	$48.60	30
Washington	514	$63.79	$38.74	18
Minnesota	492	$84.11	$58.81	18
Kansas	489	$79.87	$62.10	12
Mississippi	470	$80.25	$60.34	17
Alabama	375	$68.77	$49.55	14
Colorado	359	$75.84	$50.19	12
Connecticut	341	$66.84	$43.59	10
Iowa	339	$55.24	$32.79	15
Delaware	338	$74.01	$51.18	5
Oklahoma	325	$64.91	$39.97	11
Louisiana	271	$58.29	$41.15	10
Arkansas	265	$106.25	$86.18	8
District of Columbia	248	$47.11	$28.33	6
Nebraska	200	$67.18	$51.37	7
Nevada	136	$51.66	$28.65	6
Oregon	136	$49.24	$28.64	6
Utah	125	$84.95	$60.44	6
Montana	98	$67.99	$44.43	4
New Hampshire	89	$53.44	$35.50	2
West Virginia	72	$39.19	$19.58	3
North Dakota	72	$65.92	$40.72	4
New Mexico	65	$76.19	$52.50	3
Idaho	61	$40.89	$22.91	3
Alaska	58	$66.50	$23.00	2
Hawaii	48	$87.38	$57.38	2
South Dakota	20	$46.65	$50.00	1
Vermont	19	$49.87	$36.75	1
Maine	16	$34.73	$23.69	1

Related codes

31624Irrigation and suction of lung airways to obtain cells$57.02
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
31625Biopsy of lung airway$72.30

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.