Trends in Medicare reimbursement for screening and diagnostic procedures in lung cancer: A 10-year analysis.

33 Background: The adoption of low-dose CT (LDCT) screening and widespread use of bronchoscopic and image-guided biopsy techniques have transformed lung cancer detection. As eligibility criteria expand, timely access to these procedures is critical. However, downward pressure on Medicare reimbursement, including reductions to the conversion factor, may threaten sustainability of these services. This study evaluates national reimbursement trends for commonly used screening and diagnostic procedures in lung cancer from 2016 to 2025. Methods: Medicare reimbursement rates for commonly performed lung cancer screening and diagnostic procedures were extracted for 2016 and projected for 2025, with all values adjusted for inflation. Percent change and compound annual growth rate (CAGR) were calculated to assess temporal trends. Procedures analyzed included bronchoscopy with biopsy (31625), CT-guided lung biopsy (32405/32408), endobronchial ultrasound (EBUS) with nodal sampling (31652/31653), and low-dose computed tomography (LDCT) for lung cancer screening (71271/G0297). Results: Bronchoscopy with biopsy declined from $403.87 in 2016 to $334.14 in 2025 (–17.3%; CAGR –2.1%). CT-guided biopsy under 32405 dropped from $458.30 to $408.53 (2016–2020; –10.9%, CAGR –2.8%), while under 32408 it declined from $966.89 to $792.49 (2021–2025; –18.0%, CAGR –4.9%). LDCT screening showed consistent reduction: CPT 71271 decreased from $301.48 to $271.07 (2021–2025; –10.1%, CAGR –2.6%), and CPT G0297 from $509.86 to $482.00 (2016–2020; –5.5%, CAGR –1.4%). In contrast, EBUS reimbursement increased: 1–2 node procedures rose from $920.53 to $1155.09 (CAGR +2.6%) and ≥3 node from $978.53 to $1197.47 (CAGR +2.3%). Conclusions: Between 2016 and 2025, Medicare reimbursement declined for most lung cancer diagnostic procedures, with annualized reductions ranging from –1.4% to –4.9%. These trends are concerning given expanding screening efforts and the essential role of diagnostic access. Sustained investment and appropriate reimbursement are necessary to support early detection, ensure procedural availability, and improve lung cancer outcomes. Procedure Start Year Start Value End Year End Value Years CAGR (%) Bronchoscopy w/ Biopsy (31625) 2016 403.87 2025 334.14 9 -2.08 CT-Guided Biopsy (32405) 2016 458.3 2020 408.53 4 -2.83 CT-Guided Biopsy (32408) 2021 966.89 2025 792.49 4 -4.85 EBUS (1-2 nodes) 2016 920.53 2025 1155.09 9 2.55 EBUS (3+ nodes) 2016 978.53 2025 1197.47 9 2.27 LDCT (71271) 2021 301.48 2025 271.07 4 -2.62 LDCT (G0297) 2016 509.86 2020 482 4 -1.39