CPT code 31625 – Bronchoscopy with biopsy billing guide

Key takeaways

CPT code 31625 covers rigid or flexible bronchoscopy with bronchial or endobronchial biopsy at one or more sites, with fluoroscopic guidance included when performed.

Bill one unit per session, however many sites or bronchi are sampled. Transbronchial lung biopsy is a different code, 31628, with add-on 31633 for each additional lobe.

CPT treats 31622 as a separate procedure that’s already included in 31625, so don’t report the pair together. Modifier -59 is reserved for a genuinely distinct or staged encounter.

Practice management software like Pabau submits and tracks 31625 claims through Claim.MD, but your coders still choose the code and any modifier.

CPT code 31625: official descriptor, clinical scope, and code structure

CPT code 31625 is defined by the American Medical Association. The official descriptor reads: Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites. Three elements of that descriptor carry billing consequences.

First, “rigid or flexible” means the code applies regardless of scope type. Second, “including fluoroscopic guidance, when performed” means fluoroscopy is bundled into 31625 and can’t be billed separately. It still has to be documented when used. Third, “single or multiple sites” means that biopsy of more than one location doesn’t create a second billable unit.

How the bronchoscopy biopsy procedure works and what documentation must show

A bronchoscopy with biopsy starts with a flexible or rigid scope advanced through the mouth or nose into the tracheobronchial tree. The physician inspects the airways and takes tissue samples with biopsy forceps. Fluoroscopic guidance, when used, lets the physician position the forceps at a specific site under live imaging.

The procedure note feeds the superbill, so it must capture every element payers look for.

Payers review the operative report against six documentation requirements to determine medical necessity and correct code assignment. Missing any one can generate a medical necessity denial or a request for additional records.

• Clinical indication: State the reason for the procedure (suspected malignancy, an abnormal chest CT, hemoptysis workup) explicitly in the note. The diagnosis code alone doesn’t establish it.
• Scope type: Identify the bronchoscope as flexible or rigid. Most outpatient bronchoscopies use a flexible scope, so document it.
• Sites biopsied: Name the anatomical locations sampled (for example, right upper lobe posterior segment or left main bronchus). Generic phrases like “multiple sites” without anatomical detail create audit risk.
• Number of specimens: Record the specimen count submitted to pathology. This supports the biopsy claim and keeps pathology coding aligned.
• Fluoroscopic guidance: When used, document that fluoroscopy was performed and who operated the imaging equipment. It isn’t billed separately, so the note is the only record that the guided work happened.
• Findings and complications: Note mucosal appearance, any bleeding, and patient tolerance. This narrative supports medical necessity and separates a complete procedure from a reduced service.

Payers apply a simple standard to bronchoscopy documentation. If it isn’t in the procedure note, they treat it as if it didn’t happen.

CPT 31625 vs 31622 vs 31624 vs 31633: choosing the right bronchoscopy code

The bronchoscopy code family runs from diagnostic-only 31622 to the transbronchial add-on 31633. Selecting the wrong code is a frequent source of bronchoscopy denials. The usual mistakes are 31622 when a biopsy was taken, or 31625 when only a lavage was performed. According to the AAPC’s CPT code lookup, each code has a distinct clinical trigger.

Key distinctions: 31625 captures tissue from the bronchial or endobronchial wall. If the forceps pass through the bronchial wall into the lung parenchyma, that’s a transbronchial biopsy coded to 31628 for the first lobe. Add 31633 for each additional lobe. Confusing bronchial wall sampling with transbronchial lung sampling is a frequent upcoding risk on audit.

The chart below maps each finding in the procedure note to its code.

Billing one unit only: the single-session rule for CPT code 31625

CPT code 31625 is billed once per bronchoscopy session, however many biopsy sites are sampled. That holds even when biopsies come from both the left and right bronchi.

The phrase “single or multiple sites” in the official descriptor is the controlling language. Two units of 31625 on the same date of service is a duplicate billing error that NCCI edits will deny.

The add-on code 31633 covers additional lung lobes sampled transbronchially. It’s reported once for each lobe beyond the first, with 31628, not 31625.

Say a pulmonologist biopsied the right middle lobe bronchial wall and then lavaged the left lower lobe. The claim carries 31625 for the biopsy and 31624 for the lavage, not two units of 31625. Check the current NCCI table for the pair before adding any modifier.

Modifiers for CPT 31625: when and how to apply them

Modifier selection for CPT code 31625 determines whether claims pay, deny, or trigger an audit. Payers apply National Correct Coding Initiative (NCCI) edits, which automatically fold lower-value codes into the main code billed on the same date.

The pairing that tempts coders most is 31622 with 31625. CPT labels 31622 a separate procedure, and it’s already part of any bronchoscopy with biopsy. So the pair generally shouldn’t be reported together at all, with or without modifier -59.

Modifier -59 is the most frequently misapplied modifier on bronchoscopy claims. It’s legitimate only when the documentation shows a genuinely distinct service, such as a separate session. Appending -59 just to get past a bundling edit is a compliance violation.

Medicare reimbursement rates and fee schedule for CPT 31625

The CMS Medicare Physician Fee Schedule sets annual payment rates for CPT code 31625 that vary by place of service. Non-facility rates (office or outpatient clinic) are typically higher because the practice bears the overhead. Facility rates are lower because the hospital outpatient department, ambulatory surgery center (ASC) or inpatient facility bills separately for resources.

The figures below reflect 2025 national average rates, and CMS updates them each January. Verify current values directly through the CMS MPFS lookup before billing.

Use the FastRVU lookup tool to calculate location-adjusted reimbursement for 31625 with your practice’s geographic practice cost index (GPCI).

Prior authorization requirements for bronchoscopy biopsy

Prior authorization requirements for CPT code 31625 vary by payer type and plan. Medicare fee-for-service doesn’t require prior authorization for bronchoscopy with biopsy in most clinical scenarios. Documentation must still support medical necessity under the applicable Local Coverage Determinations (LCDs). Medicare Advantage plans and commercial insurers are more complex, so check authorization as part of eligibility verification at scheduling.

• Medicare fee-for-service: Generally no prior authorization for bronchoscopy with biopsy. Medical necessity is judged after submission against the applicable LCD. Make sure the ICD-10 diagnosis code aligns with LCD criteria (suspected malignancy, unexplained hemoptysis, abnormal imaging).
• Medicare Advantage: Many plans require prior authorization. Requirements differ by plan, so verify with the specific plan before scheduling. Failing to obtain authorization results in denial and weaker appeal leverage.
• Commercial insurers: Authorization policies vary widely. High-deductible plans and managed care products are most likely to require it. Obtain written authorization confirmation that names the specific CPT code authorized.
• Medicaid: Many state Medicaid programs require prior authorization for bronchoscopy. Approval can take time, so plan scheduling accordingly.

When authorization is obtained, record the authorization number on the claim and in the patient’s chart. Claims submitted without a required authorization number are denied on a technical basis. Those denials are harder to overturn on appeal than medical necessity denials.

Common denial reasons for CPT 31625 and how to prevent them

Most denials on CPT code 31625 are preventable. The medical billing denial codes payers return on bronchoscopy claims cluster around four root causes. They are unbundling, duplicate billing, missing documentation, and missing authorization. Knowing the trigger for each denial type lets practices fix the cause instead of appealing claim by claim.

Denial management for bronchoscopy claims works best when practices track denial reasons by code rather than by claim volume. A recurring reason on 31625 usually points to one fixable habit in the procedure note or the charge entry.

Codes commonly billed with CPT 31625: companion codes and NCCI considerations

Bronchoscopy with biopsy rarely appears as a standalone claim. Pulmonologists often perform additional procedures in the same session, and the pathologist bills separately for the specimens. Knowing which companion codes NCCI bundles and which are separately billable is essential for a clean 837 electronic claim. Check each pair against the current NCCI table before the claim leaves the practice.

Pathology codes (88305, 88307) are submitted by the laboratory or pathologist as a separate claim. The bronchoscopist doesn’t report pathology codes. Including pathology on the physician’s claim generates an unbundling denial.

How claims management software supports CPT 31625 billing

In many pulmonology practices, a coder checks the procedure note against the code by hand. The claim is then re-keyed into a clearinghouse portal, and rejections get chased through a separate inbox.

Pabau’s claims software for specialty practices keeps the procedure note, the diagnosis and the charge on one patient record. The claim is pre-filled from data already on that record and submitted through Pabau’s Claim.MD integration.

Your coders still choose the CPT code and any modifier. Claim.MD returns clearinghouse edit responses and claim status, and remittances come back with their denial reason codes. Your team sees why a 31625 claim was rejected and fixes that cause instead of guessing.

Streamline bronchoscopy billing with Pabau

Pabau keeps the procedure note, diagnosis and charge on one record, then submits and tracks bronchoscopy claims through Claim.MD. Your team sees each rejection reason and fixes it faster.

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Conclusion

Correct billing for CPT code 31625 starts with the procedure note, not the code list. The specimen type decides between 31625, 31624 and 31628, and the unit count stays at one.

The habit worth breaking is reaching for modifier -59 whenever 31622 lands on the same claim. Drop 31622 instead, and keep -59 for the rare encounter the documentation genuinely separates.

Practices that settle those two decisions at the note stage spend far less time on appeals. Book a demo to see how Pabau keeps bronchoscopy notes, charges and claim status on one record.

Continue your research

Need a framework for managing claim denials across your pulmonology practice? Denial management in healthcare covers the systematic approach to tracking, appealing, and preventing claim rejections.

Want to understand how electronic claims move from submission to payment? Electronic remittance advice (ERA) explains how 835 remittance files carry CARC codes back to your billing team after every adjudicated claim.

Looking for a clean-claim checklist before submission? What is a clean claim outlines the elements every bronchoscopy and procedure claim must include to avoid preventable rejections.

Filing bronchoscopy claims electronically? What is an 837 file? walks through the electronic claim format that carries 31625 and its companion codes to the payer.

Auditing your billing against federal rules? Medical billing compliance explains the laws behind unbundling and modifier misuse, with a downloadable checklist.

Frequently asked questions