C7512 Bronchoscopy EBUS Biopsy Reimbursement | OpenPayer

Summary & Overview

HCPCS C7512: Bronchoscopy with EBUS-Guided Biopsy for Peripheral Lesions

HCPCS Level II code C7512 represents a bronchoscopy procedure — rigid or flexible — that includes single or multiple bronchial or endobronchial biopsies performed with transendoscopic endobronchial ultrasound (ebus) for peripheral lung lesions, with fluoroscopic guidance when performed. This code captures an advanced, image-guided diagnostic and potentially therapeutic intervention that combines tissue sampling with real-time ultrasound visualization of endobronchial and peribronchial structures.

This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the procedure, the typical settings where the service is delivered, and the payer landscape addressed in the publication. The report highlights how this code is used to identify complex bronchoscopy with ebus for peripheral lesions, and outlines benchmarking and policy implications relevant to providers, billing specialists, and payers.

The publication provides benchmarks for utilization and reimbursement patterns where available, notes recent policy and coding guidance affecting adoption and coverage, and situates the procedure within contemporary diagnostic algorithms for peripheral pulmonary lesions. Data not available in the input will be identified explicitly in relevant sections of the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC7512HCPCS Level IIbronchoscopyendobronchial ultrasoundebusbiopsypulmonaryhospital outpatientambulatory surgical center

Billing Code Overview

HCPCS Level II code C7512 describes a bronchoscopy procedure — rigid or flexible — with single or multiple bronchial or endobronchial biopsy(ies) at one or more sites, performed along with transendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s). The description notes inclusion of fluoroscopic guidance when performed.

Service type: Diagnostic and/or therapeutic bronchoscopic procedure with endobronchial ultrasound-guided biopsy
Typical site of service: Hospital outpatient department or ambulatory surgical center; may also occur in specialized bronchoscopy suites within hospitals

Clinical & Coding Specifications

Clinical Context

A 64-year-old patient with a 40-pack-year smoking history presents with a 2.5 cm solitary peripheral right upper lobe lung nodule on CT with PET uptake and mild enlargement of ipsilateral hilar lymph nodes. The pulmonologist schedules a diagnostic bronchoscopy with endobronchial ultrasound-guided transbronchial biopsy to sample the peripheral lesion and target accessible endobronchial or hilar lymph nodes during the same anesthetic. The procedure is performed in an endoscopy suite or operating room under monitored anesthesia care or general anesthesia with fluoroscopic guidance. The workflow includes pre-procedure consent and evaluation, airway management (rigid or flexible bronchoscope), placement of a transendoscopic EBUS probe to visualize and sample peribronchial tissue, targeted endobronchial biopsies of suspicious mucosal lesions if present, specimen collection for pathology and molecular testing, and post-procedure recovery with observation for complications such as bleeding or pneumothorax. Documentation includes the approach (rigid or flexible), number and sites of biopsies, use of EBUS, fluoroscopy, anesthesia type, hemostasis measures, and pathology routing instructions.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for the bronchoscopy/biopsy due to complexity, extensive adhesions, or prolonged time; supporting documentation required.

HCPCS C7529: Coronary Angiography with Right/Left Heart Catheterization & Physiology

HCPCS-C9755-PERCUTANEOUS-MAGNETIC-GUIDED-AV-FISTULA-CREATION-RF

HCPCS C9755: Percutaneous Magnetic-Guided Arteriovenous Fistula Creation

HCPCS-C7540-PACEMAKER-GENERATOR-REPLACEMENT-DUAL-LEAD-LV-PACING

HCPCS C7540: Pacemaker Generator Replacement with LV Lead, Dual-Lead System

HCPCS-C2640-PALLADIUM-103-BRACHYTHERAPY-SOURCE-STRANDED

HCPCS C2640: Brachytherapy Source, Stranded Palladium-103, Per Source

HCPCS-C8009-REMOVAL-HYPOGLOSSAL-NEUROSTIMULATOR-EXPLANTATION

HCPCS C8009: Removal of Hypoglossal Nerve Neurostimulator Array and Pulse Generator

HCPCS-C9053-CRIZANLIZUMAB-INJECTION-1MG

HCPCS C9053: Crizanlizumab-tmca Injection, 1 mg

HCPCS-C9290-BUPIVACAINE-LIPOSOME-INJECTION-1MG

HCPCS C9290: Injection, bupivacaine liposome, 1 mg

HCPCS-C2699-BRACHYTHERAPY-SOURCE-NON-STRANDED-PER-SOURCE

HCPCS Level II C2699: Brachytherapy Source, Non-Stranded, Per Source

HCPCS-C2618-CRYOABLATION-PROBE-NEEDLE

HCPCS C2618: Cryoablation Probe/Needle

HCPCS-C2631-URINARY-INCONTINENCE-DEVICE-REPAIR-NO-SLING-GRAFT

HCPCS C2631: Repair Device for Urinary Incontinence, No Sling Graft

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Taxonomy Code	Specialty	Notes
`2084P0800X`	Pulmonology	Bronchoscopies with EBUS are commonly performed by interventional pulmonologists.
`2086S0123X`	Thoracic Surgery	Thoracic surgeons perform diagnostic and therapeutic bronchoscopic interventions in OR settings.
`363L00000X`	Anesthesiology	Anesthesiologists or CRNAs provide monitored anesthesia care or general anesthesia for complex bronchoscopic procedures.
`207RP0500X`	Critical Care Medicine	Intensivists may perform or assist with airway procedures in critically ill patients.
`363A00000X`	Nurse Anesthetist	CRNAs commonly deliver anesthesia for bronchoscopic procedures in procedural suites and ASC settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.11`	Malignant neoplasm of upper lobe, right bronchus or lung	Peripheral lung nodule suspicious for primary lung cancer is a common indication for EBUS-guided bronchoscopic biopsy.
`C34.12`	Malignant neoplasm of middle lobe, right bronchus or lung	Similar indication when lesions are in middle lobe requiring bronchoscopic sampling.
`C34.31`	Malignant neoplasm of upper lobe, left bronchus or lung	Left-sided peripheral lesions often require EBUS-assisted biopsy for diagnosis and staging.
`J98.4`	Other disorders of lung, not elsewhere classified	Used for nonspecific endobronchial abnormalities or when biopsy is needed to clarify atypical findings.
`J84.10`	Pulmonary fibrosis, unspecified	Interstitial or peripheral lung disease may prompt bronchoscopic biopsy to evaluate for alternative diagnoses or superimposed malignancy.
`R91.8`	Other nonspecific abnormal radiologic findings of lung field	Commonly used for CT-detected pulmonary nodules or masses that require tissue diagnosis via bronchoscopy.
`R04.2`	Hemoptysis, not elsewhere classified	Diagnostic bronchoscopy with biopsy may be performed when bleeding source or tumor is suspected.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31622`	Bronchoscopy, rigid, diagnostic, with or without tracheoscopy; with transbronchial biopsy(s)	Alternative or preceding approach when rigid bronchoscopy is required for airway control or access during biopsies; may be billed when rigid technique is used.
`32405`	Endobronchial/transbronchial biopsy, single or multiple, from central lesions (included in higher-level codes)	Represents transbronchial biopsy work; may be reported or bundled depending on payer and documentation; used when separate reporting is allowed.
`32851`	Thoracoscopy, diagnostic; with or without pleural biopsy	Performed when pleural-based disease is suspected and thoracoscopic biopsy is required in addition to bronchoscopic sampling.
`31628`	Bronchoscopy, rigid or flexible, with placement of endobronchial or endotracheal stent	Performed when therapeutic airway stenting is required in the same session for airway compromise found during diagnostic bronchoscopy.
`32810`	Thoracentesis, needle drainage of pleural space	May be performed before or after bronchoscopy when pleural effusion sampling is clinically indicated to stage or diagnose lung disease.

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