Summary & Overview

HCPCS C2613: Lung Biopsy Plug with Delivery System

HCPCS Level II code C2613 designates a lung biopsy plug supplied with a delivery system used to seal biopsy tracts after percutaneous or transbronchial lung biopsy. As a device/supply code tied to minimally invasive pulmonary procedures, it matters nationally because it affects device reimbursement, facility supply billing, and complication mitigation strategies for lung biopsy services.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage considerations, typical sites of service where the device is used (hospital outpatient departments, ambulatory surgery centers, and interventional radiology suites), and the clinical context for use in reducing post‑biopsy air leak and bleeding.

The report outlines common billing practices, relevant modifiers listed in the input, and where available, payer-specific coverage characteristics and reimbursement benchmarks. It highlights policy updates and coding guidance that affect device supply reporting and facility billing for lung biopsy adjuncts. The content is intended for billing managers, clinicians involved in pulmonary procedures, and revenue cycle professionals seeking a national perspective on coding and billing for this lung biopsy device.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC2613HCPCS Level IIlung biopsybiopsy plugprocedural deviceinterventional radiologyambulatory surgery centerhospital outpatient

Billing Code Overview

HCPCS Level II code C2613 describes a lung biopsy plug with delivery system. This supply/device code represents a product used to seal or plug the tract created during percutaneous or transbronchial lung biopsy procedures to reduce post‑procedure air leak or bleeding.

Service Type: Biopsy adjunct / procedural device

Typical Site of Service: Hospital outpatient setting, ambulatory surgery center, or interventional radiology suite

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 64-year-old patient with a newly identified peripheral pulmonary nodule on chest CT is referred for transthoracic lung biopsy. Under conscious sedation in the interventional radiology suite, percutaneous image-guided biopsy is performed to obtain tissue for histopathology. After core biopsy samples are obtained, a C2613 lung biopsy plug with delivery system is deployed through the biopsy tract to reduce the risk of post-procedural pneumothorax and provide hemostasis. The clinical workflow includes pre-procedure informed consent, image localization (CT or fluoroscopy), needle placement and tissue acquisition, deployment of the plug, immediate post-procedure imaging to assess for pneumothorax or hemorrhage, and short observation with pulse oximetry and chest radiograph prior to discharge or inpatient transfer. The procedure is typically performed by an interventional radiologist or thoracic surgeon in an outpatient ambulatory surgery center or hospital interventional suite, with typical monitoring in the post-anesthesia care area.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to place the plug is substantially greater than typical due to complexity or complication.
`23`	Unusual anesthesia	Use when general anesthesia is required for the biopsy and plug placement instead of usual sedation.
`52`	Reduced services	Use when the lung biopsy plug procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when the procedure is started but terminated for patient safety prior to plug deployment.
`54`	Surgical care only	Use when only the surgical portion (plug placement) is billed separately from pre/post care by another provider.
`55`	Postoperative management only	Use when only postoperative care is billed by one provider separate from the surgeon who placed the plug.
`56`	Preoperative management only	Use when only preoperative evaluation is billed separately from the provider who performs the plug placement.
`62`	Two surgeons	Use when two surgeons of different specialties are required to perform the biopsy and plug placement together.
`LT`	Left side	Use to report laterality when the plug is placed in the left lung biopsy tract.
`RT`	Right side	Use to report laterality when the plug is placed in the right lung biopsy tract.
`QK`	Medical direction of two, three, or four assistants	Use when the reporting physician medically directs qualified assistants during the procedure.
`QX`	Private practitioner with assistant	Use when a qualified assistant who meets state law provides assistance and billing requires the modifier.
`QY`	Medical direction of one assistant	Use when the physician medically directs one qualified assistant for the procedure.
`QZ`	Personal assistant (not in original list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`2085R0400X`	Interventional Radiology	Primary specialty performing image-guided lung biopsy and plug placement.
`207T00000X`	Thoracic Surgery	Thoracic surgeons may perform percutaneous or surgical lung biopsy with tract plug.
`207L00000X`	Pulmonary Disease (Interventional Pulmonology)	Pulmonologists performing bronchoscopic or transthoracic biopsy procedures and adjunctive plug use.
`363L00000X`	General Surgery	General surgeons involved in thoracic procedures in some settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Pulmonary nodule suspicious for primary lung cancer prompting biopsy and plug placement.
`C78.01`	Secondary malignant neoplasm of right lung	Metastatic lesion in the lung targeted for diagnostic biopsy and tract sealing.
`R91.1`	Solitary pulmonary nodule	Common indication for percutaneous biopsy with subsequent plug placement to reduce complications.
`J98.4`	Other disorders of lung, not elsewhere classified (includes pulmonary nodule evaluation)	Used when specific lung pathology is under evaluation with biopsy.
`J95.2`	Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified	Coded if procedure results in complications such as persistent pneumothorax requiring intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32405`	Biopsy, lung or mediastinum, percutaneous needle; with imaging guidance (e.g., CT)	Commonly performed immediately before plug deployment to obtain diagnostic tissue.
`32480`	Insertion of chest tube, pleural drainage catheter, percutaneous	Performed if a pneumothorax occurs after biopsy and plug placement requiring drainage.
`99213`	Office or other outpatient visit, established patient, moderate complexity	May represent pre-procedure evaluation visit for outpatient candidates undergoing biopsy and plug placement.
`94010`	Spirometry, simple; performed pre-procedure when lung function assessment is needed	Pre-procedure pulmonary function testing commonly used to assess risk prior to lung biopsy.
`71020`	Radiologic examination, chest; two views, frontal and lateral	Standard post-procedure chest radiograph to evaluate for pneumothorax after plug placement.