Last Updated: January 2026 | Verified for 2026 AMA, CPT & CMS Guidelines
Bronchoscopy CPT codes live primarily in the 31600 series and are written as procedural composites: each code assumes scope passage, airway inspection, and routine field management (including routine suctioning). Therefore, when a biopsy, aspiration, stent, valve, or other intervention is performed, the diagnostic bronchoscopy (31622) is treated as included and should not be billed separately in the same encounter. CMS NCCI policy is the most important “hard rule” reference for this concept and is widely mirrored by commercial payer edits.
The practical consequence is simple: if you bill 31622 plus another 316xx code on the same date without a clear separation (separate encounter or distinct session), the 31622 line is likely to deny or be recouped. In addition, when multiple interventional bronchoscopy codes are legitimately reportable, payers typically apply multiple-procedure reductions automatically, while add-on codes are paid in addition when the parent code is present.
Use 31622 only when the service is a diagnostic airway evaluation with no separately reportable intervention. A key nuance is that “cell washing” is included in 31622; minimal saline instillation for cytology does not transform the service into BAL. CMS bundling principles and coding guidance emphasize that 31622 is a “stand-alone only” code in the presence of other bronchoscopic interventions.
31623 applies when a bronchial brushing is documented (including protected brushings). Brushings are distinct from cell washing, and can be separately reportable when performed with other sampling (e.g., biopsy) if the report demonstrates distinct sampling intent and technique. When payer edits trigger, a distinct modifier may be necessary, but the clinical record should be the driver: document lesion/site and that brushing was obtained for cytology.
31624 requires documentation consistent with a true BAL (typically larger-volume instillation and return in a targeted segment or lobe). A recurrent audit failure is vague wording (“washing obtained”) without volume, location, or return. Best practice is to document aliquots and totals (instilled and recovered) and state the diagnostic/therapeutic purpose (e.g., evaluate infection, diffuse infiltrates). Guidance differentiating simple washing vs BAL emphasizes that volume and intent are decisive.
BAL vs washing: If the note only supports minimal rinsing or routine suctioning, default to 31622 (or no separate lavage code when another intervention is billed). If the note clearly supports large-volume lavage with return and a defined target site, 31624 is appropriate.
31625 is for forceps biopsy of tissue in the airway lumen (endobronchial). It is not unit-based for the number of bites; “single or multiple sites” are included within one code per session. When both endobronchial biopsy and other sampling are performed, separate reporting hinges on whether the services are truly distinct (different technique and/or different target). As a payer-facing strategy, link each CPT to the most relevant diagnosis/target to demonstrate medical necessity for each component.
31628 is transbronchial lung biopsy in a single lobe. If more than one lobe is biopsied, report +31632 per additional lobe (not per specimen). This is a classic area where documentation must explicitly name lobes, because the CPT structure is lobe-based. A procedure note that lists only “TBLB performed” without lobar detail is vulnerable to downcoding (loss of add-on payment) or denial (insufficient specificity).
31629 describes TBNA performed through the bronchoscope without EBUS guidance. If EBUS guidance is used, do not use 31629 for those node samples; use 31652/31653 instead. This distinction is not optional: it is a technique-driven code family decision, and incorrect selection is a common compliance issue.
Clinically, it is common to sample both a lung lesion and mediastinal/hilar nodes in one session. Coding is permissible when the services are distinct and documented (e.g., transbronchial biopsy of a peripheral lesion plus separate nodal sampling). Commentary in the pulmonary coding literature highlights that combinations may be appropriate when sites and intent differ, even if payer systems sometimes require modifiers to bypass automated bundling logic.
EBUS codes are defined by lymph node station count, not needle passes. Choose 31652 when sampling 1–2 stations and 31653 when sampling 3 or more. To code correctly, the procedure note should list the stations sampled (e.g., 4R, 7, 11L) and make clear that ultrasound guidance was used. This station-based structure makes EBUS relatively “audit-friendly” when documented properly—and vulnerable when the note is vague.
Add-on 31654 is for ultrasound used during bronchoscopic diagnostic/therapeutic interventions targeting peripheral lesions (commonly radial EBUS). It is reported once per session when applicable and must be linked to the primary intervention (biopsy, brushing, lavage, etc.). The note should describe ultrasound localization of the peripheral target and the subsequent intervention performed.
31627 is an add-on for computer-assisted, image-guided navigation (electromagnetic or similar) performed during bronchoscopy. It does not replace the primary intervention code; it is appended to whatever service was done once the target was reached (e.g., 31628 biopsy, 31626 fiducial placement). Medicare contractor education emphasizes correct reporting of navigation when performed and the need to document the navigation system/technique.
31626 is used for bronchoscopic placement of fiducial markers (single or multiple). In practice, it is frequently paired with navigation (31627) because navigation helps reach peripheral targets. Documentation should state the type of marker, target site, and purpose (e.g., radiation planning or surgical localization). In multi-service sessions, ensure the record separates “marker placement” from “tissue sampling” so that payer logic recognizes distinct clinical intent, not duplicative steps.
31635 applies when a foreign body is removed from the airway via bronchoscopy. The diagnostic component is included, and NCCI policy supports non-separate reporting of 31622. If additional distinct services are performed (e.g., biopsy of a separate lesion), they may be reported with appropriate distinct modifiers and clear site documentation.
31645 is therapeutic aspiration (initial) for significant airway clearance (mucus plugs, blood, pus) beyond routine suctioning. A frequent denial reason is documentation that describes secretions but does not explicitly state therapeutic aspiration or airway clearance as an intervention. If additional distinct areas require therapeutic aspiration, add-on 31646 may apply; the report should clearly differentiate sites to support the add-on.
Airway dilation, stent placement, and tumor debulking are high-scrutiny services because they often involve multiple sequential steps. A core coding principle is that component steps are not separately billed when they are necessary to accomplish the definitive service. For example, when dilation is performed as part of stent placement, payer bundling logic typically treats dilation as included. Contractor and coding Q&A sources frequently reinforce this pattern (component work folded into the definitive code).
Stent placement codes are location-driven (tracheal vs bronchial) and may have add-ons for additional bronchi. Documentation should include location, device type/size, and confirmation of position. For stent revision problems, use the appropriate “revision” concept only when the service is truly revision/repositioning rather than a new placement; the decisive factor is the clinical intent and final outcome documented.
Tumor therapy codes separate mechanical excision from destructive modalities (laser, electrocautery, cryotherapy). In mixed-method cases, select the code that best reflects the primary method and intended therapeutic service. When tumor debulking is performed solely to enable another definitive intervention (e.g., stent placement in the same site), expect payer logic to treat debulking as integral unless the record demonstrates a separate lesion and separate therapeutic objective.
Valve codes are structured by lobe: 31647 (initial lobe insertion) with add-on 31651 for additional lobes; 31648 (initial lobe removal) with add-on 31649 for additional lobes. Policy descriptions emphasize that insertion includes key assessment steps (balloon occlusion, air leak assessment, airway sizing) as inherent work. Therefore, do not unbundle those steps into separate services. Coverage is indication- and criteria-driven (e.g., emphysema selection standards, persistent air leak context) and varies by payer.
Thermoplasty is staged and coded by lobes treated: 31660 for one lobe and add-on 31661 for each additional lobe treated in the same session. The clinical record should name lobes and describe that thermoplasty was delivered (often with activations count) to support the service. Coverage is payer-sensitive and frequently requires documentation of severe persistent asthma and prior failure of maximal medical therapy; a practical strategy is to ensure those elements exist in the record, not only in the procedure note.
For bronchoscopy, modifiers are not “payment hacks”; they are documentation-dependent declarations of separation. The two most important modifier situations are: (1) distinct structure/lesion within one session and (2) separate encounter (rare, but possible). CMS recognizes 59 and the more specific X{EPSU} modifiers (XE, XS, XP, XU). If your payer recognizes X modifiers, use the most specific option to describe why the service is distinct (e.g., XS for different lung structure or XU for unusual non-overlapping service) rather than defaulting to 59. Medicare educational materials emphasize using distinct-procedure modifiers only when criteria are met.
Medicare generally applies multiple-procedure reductions automatically. Some commercial payers still request modifier 51 on secondary procedures, but Medicare typically does not require it. Because payer rules vary, a practical workflow is to configure payer-specific claim rules (e.g., 51 required vs not) and keep the clinical documentation consistent: site, technique, and intent. Finally, Medicare does not cover screening bronchoscopy in asymptomatic patients; medical necessity must be evident in diagnosis and records.
If a reviewer must decide whether multiple bronchoscopy codes are payable, they will look for objective anchors in the record. Use this checklist to reduce audit risk:
| CPT | What it represents | Unit logic | Common pitfalls |
|---|---|---|---|
| 31622 | Diagnostic scope +/- minor washing | Once per session | Billing with another 316xx in same encounter (bundled) |
| 31623 | Brushing | Once per session | Not documenting site/lesion; missing rationale for multi-sampling |
| 31624 | BAL | Once per target BAL | No volume/return documented; confusing with washing |
| 31628 | TBLB, single lobe | By lobe | Failing to identify lobes; losing +31632 |
| 31652/31653 | EBUS TBNA by station count | 1–2 vs ≥3 stations | Not listing stations; miscoding TBNA as 31629 despite EBUS |
| +31627 | Navigation add-on | Once per session | Billing without documenting navigation system/technique |
| 31647–31651 | Valve insertion/removal by lobe | Initial lobe + add-on lobes | Unbundling assessment steps; weak patient-selection documentation |
| 31660–31661 | Thermoplasty by lobe | Initial lobe + add-on lobes | Insufficient asthma severity documentation/coverage criteria |
Work: Visible lesion in bronchus brushed for cytology and biopsied with forceps.
Code: 31623 + 31625 (consider XS/59 if payer edits trigger).
Documentation: Lesion location + separate statements for brushing and biopsy (two techniques, one lesion).
Work: BAL performed in RML for infection workup; separate TBLB performed in RUL nodule.
Code: 31624 + 31628 (append XS/59 to indicate separate lobe if needed).
Documentation: BAL volumes + lobes named for each service.
Work: EBUS TBNA of stations 4R, 7, 11L (three stations), plus navigated transbronchial biopsy of peripheral mass with radial EBUS localization.
Code: 31653 + 31628 (XS/59 as needed) + 31654 + 31627.
Documentation: Stations listed (drives 31653), navigation described (drives 31627), radial EBUS for peripheral lesion (drives 31654).
Work: Peanut removed from right main bronchus; separate suspicious lesion in left bronchus biopsied.
Code: 31635 + 31625 (XS/59 on biopsy).
Documentation: Two different sides/targets; separate indication linkage.
Work: Valves placed in a single lobe; assessment steps performed as part of procedure.
Code: 31647 (add 31651 only if an additional lobe treated).
Documentation: Lobe treated, number/segments, and patient-selection rationale for coverage.
Work: Thermoplasty performed in two lobes in one session (protocol-driven).
Code: 31660 + 31661.
Documentation: Lobes named; severe asthma indication and clinical selection evidence in record.
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