CPT code 31645: Bronchial aspiration, initial therapeutic aspiration2026 Medicare rate & RVUs
Reports initial bronchoscopic therapeutic aspiration to clear airway secretions, mucus plugs, or other material obstructing the tracheobronchial tree.
Medicare pays $308.29 for 31645 nationally in the office and $133.27 in a hospital or facility. Local office rates run $274.72–$404.62.
Medicare rate · 31645
Bronchial aspiration, initial therapeutic aspiration
- Work RVUs
- 2.81
- Total RVUs
- 9.23
- Global days
- 000
National rate · 2026
$308.29
Office setting, before claim adjustments.
See every locality for 31645 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 31645 covers
A pulmonologist, interventional pulmonologist, or other qualified physician uses a bronchoscope to aspirate material from the trachea or bronchi. Typical situations include clearing tenacious secretions or mucus plugging associated with atelectasis, impaired airway clearance, or respiratory distress, including in hospitalized or intensive care patients. This is therapeutic airway clearance, not aspiration performed solely to collect a diagnostic specimen.
Report 31645 for the initial therapeutic aspiration; report 31646 for subsequent therapeutic aspiration when appropriate. Document the clinical reason for airway clearance and the material and airway sites treated. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 31645 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$274.72 to $404.62
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $278.49 | $125.35 |
| Alaska | $364.18 | $177.78 |
| Arizona | $300.55 | $130.95 |
| Arkansas | $274.72 | $124.38 |
| Atlanta, GA | $313.79 | $135.97 |
| Austin, TX | $319.25 | $134.08 |
| Bakersfield, CA | $325.94 | $134.12 |
| Baltimore area, MD | $327.03 | $139.24 |
| Beaumont, TX | $289.18 | $129.91 |
| Brazoria, TX | $305.07 | $131.62 |
| Chicago, IL | $322.51 | $146.62 |
| Chico, CA | $325.05 | $133.22 |
| Colorado | $320.40 | $134.18 |
| Connecticut | $327.97 | $139.47 |
| Dallas, TX | $306.94 | $132.62 |
| Delaware | $305.32 | $132.40 |
| Detroit, MI | $307.77 | $138.87 |
| East St. Louis, IL | $301.73 | $140.71 |
| El Centro, CA | $325.10 | $133.27 |
| Fort Lauderdale, FL | $318.78 | $141.48 |
| Fort Worth, TX | $305.02 | $132.45 |
| Fresno, CA | $325.05 | $133.22 |
| Galveston, TX | $305.94 | $132.15 |
| Hanford, CA | $325.05 | $133.22 |
| Hawaii, Guam, HI | $332.26 | $133.26 |
| Houston, TX | $311.25 | $137.45 |
| Idaho | $286.81 | $125.79 |
| Indiana | $288.37 | $126.12 |
| Iowa | $285.05 | $124.90 |
| Kansas | $283.83 | $125.61 |
| Kentucky | $284.74 | $129.15 |
| King County, WA | $357.69 | $142.94 |
| Los Angeles, CA | $346.35 | $139.30 |
| Madera, CA | $325.05 | $133.22 |
| Manhattan, NY | $353.14 | $149.77 |
| Marin County, CA | $395.91 | $149.13 |
| Merced, CA | $325.05 | $133.22 |
| Metropolitan Boston, MA | $350.79 | $141.82 |
| Metropolitan Kansas City, MO | $295.58 | $131.23 |
| Metropolitan Philadelphia, PA | $320.24 | $138.05 |
| Metropolitan St. Louis, MO | $298.48 | $131.86 |
| Miami, FL | $331.50 | $149.30 |
| Minnesota | $307.41 | $127.31 |
| Mississippi | $277.30 | $126.61 |
| Modesto, CA | $325.05 | $133.22 |
| Montana | $308.27 | $133.25 |
| Napa, CA | $374.55 | $143.87 |
| Nebraska | $286.50 | $124.96 |
| Nevada | $306.88 | $131.68 |
| New Hampshire | $315.47 | $133.28 |
| New Mexico | $293.24 | $132.75 |
| New Orleans, LA | $297.53 | $132.83 |
| North Carolina | $291.08 | $127.78 |
| North Dakota | $302.54 | $127.52 |
| Northern New Jersey | $347.62 | $144.60 |
| NYC suburbs and Long Island, NY | $361.30 | $153.20 |
| Ohio | $290.55 | $130.76 |
| Oklahoma | $284.22 | $127.93 |
| Oxnard, CA | $344.53 | $137.66 |
| Portland, OR | $330.04 | $135.59 |
| Poughkeepsie and northern NYC suburbs, NY | $334.00 | $142.35 |
| Puerto Rico | $310.40 | $133.45 |
| Queens, NY | $355.84 | $148.97 |
| Redding, CA | $325.05 | $133.22 |
| Rest of California | $325.05 | $133.22 |
| Rest of Florida | $304.15 | $136.83 |
| Rest of Georgia | $288.04 | $131.92 |
| Rest of Illinois | $295.93 | $136.14 |
| Rest of Louisiana | $284.34 | $129.44 |
| Rest of Maine | $288.25 | $127.23 |
| Rest of Maryland | $310.89 | $133.77 |
| Rest of Massachusetts | $318.68 | $134.38 |
| Rest of Michigan | $291.73 | $131.93 |
| Rest of Missouri | $279.78 | $128.92 |
| Rest of New Jersey | $331.82 | $140.70 |
| Rest of New York | $295.18 | $128.91 |
| Rest of Oregon | $304.59 | $130.27 |
| Rest of Pennsylvania | $290.97 | $130.30 |
| Rest of Texas | $296.91 | $130.81 |
| Rest of Washington | $318.05 | $133.75 |
| Rhode Island | $315.78 | $134.99 |
| Riverside, CA | $328.21 | $136.39 |
| Sacramento, CA | $340.55 | $137.00 |
| Salinas, CA | $339.26 | $136.41 |
| San Benito County, CA | $404.62 | $152.24 |
| San Diego, CA | $346.80 | $137.48 |
| San Francisco, CA | $395.58 | $148.80 |
| San Luis Obispo, CA | $333.85 | $134.50 |
| Santa Clara County, CA | $403.27 | $150.89 |
| Santa Cruz, CA | $349.79 | $137.14 |
| Santa Maria, CA | $340.41 | $136.34 |
| Santa Rosa, CA | $353.29 | $138.37 |
| South Carolina | $291.28 | $129.56 |
| South Dakota | $301.86 | $126.84 |
| Southern Maine, ME | $302.87 | $129.43 |
| Stockton, CA | $325.05 | $133.22 |
| Suburban Chicago, IL | $321.95 | $142.21 |
| Tennessee | $285.17 | $126.08 |
| Utah | $295.02 | $130.50 |
| Vallejo, CA | $374.07 | $143.40 |
| Vermont | $301.46 | $128.19 |
| Virgin Islands, VI | $310.40 | $133.45 |
| Virginia | $301.96 | $129.92 |
| Visalia, CA | $325.05 | $133.22 |
| Washington, DC area | $350.90 | $144.72 |
| West Virginia | $285.64 | $133.55 |
| Wisconsin | $292.99 | $125.32 |
| Wyoming | $305.77 | $130.75 |
| Yuba City, CA | $325.05 | $133.22 |
31645 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$274.72
$364.84
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $364.18 | 1 |
| AL | $278.49 | 1 |
| AR | $274.72 | 1 |
| AZ | $300.55 | 1 |
| CA | $325.05–$404.62 | 29 |
| CO | $320.40 | 1 |
| CT | $327.97 | 1 |
| DC | $350.90 | 1 |
| DE | $305.32 | 1 |
| FL | $304.15–$331.50 | 3 |
| GA | $288.04–$313.79 | 2 |
| GU | $332.26 | 1 |
| HI | $332.26 | 1 |
| IA | $285.05 | 1 |
| ID | $286.81 | 1 |
| IL | $295.93–$322.51 | 4 |
| IN | $288.37 | 1 |
| KS | $283.83 | 1 |
| KY | $284.74 | 1 |
| LA | $284.34–$297.53 | 2 |
| MA | $318.68–$350.79 | 2 |
| MD | $310.89–$350.90 | 3 |
| ME | $288.25–$302.87 | 2 |
| MI | $291.73–$307.77 | 2 |
| MN | $307.41 | 1 |
| MO | $279.78–$298.48 | 3 |
| MS | $277.30 | 1 |
| MT | $308.27 | 1 |
| NC | $291.08 | 1 |
| ND | $302.54 | 1 |
| NE | $286.50 | 1 |
| NH | $315.47 | 1 |
| NJ | $331.82–$347.62 | 2 |
| NM | $293.24 | 1 |
| NV | $306.88 | 1 |
| NY | $295.18–$361.30 | 5 |
| OH | $290.55 | 1 |
| OK | $284.22 | 1 |
| OR | $304.59–$330.04 | 2 |
| PA | $290.97–$320.24 | 2 |
| PR | $310.40 | 1 |
| RI | $315.78 | 1 |
| SC | $291.28 | 1 |
| SD | $301.86 | 1 |
| TN | $285.17 | 1 |
| TX | $289.18–$319.25 | 8 |
| UT | $295.02 | 1 |
| VA | $301.96–$350.90 | 2 |
| VI | $310.40 | 1 |
| VT | $301.46 | 1 |
| WA | $318.05–$357.69 | 2 |
| WI | $292.99 | 1 |
| WV | $285.64 | 1 |
| WY | $305.77 | 1 |
How the 31645 rate is calculated
Each of 31645’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 31645
RVUs × geographic indexes × conversion factor
Work2.81
2.81 RVUs× 1.000 GPCI
Practice expense6.13
6.13 RVUs× 1.000 GPCI
Malpractice0.29
0.29 RVUs× 1.000 GPCI
Adjusted RVUs
9.2300
Conversion factor
$33.4009
Medicare rate
$308.29
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31645
The CMS indicators that decide how 31645 is paid alongside other services.
CMS payment indicators · 31645
Bronchial aspiration, initial therapeutic aspiration
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
31645 without 51 · national office
$308.29
Bronchial aspiration, initial therapeutic aspiration
31645-51 · Second procedure: 50%
$154.15
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
31645 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 31646Bronchoscopic aspirationSubsequent aspiration
- 31645 is for the initial therapeutic aspiration; 31646 is the add-on for subsequent therapeutic aspiration.
- 31624BronchoscopyBronchoalveolar lavage
- Choose 31624 when bronchoalveolar lavage is performed for lavage or sampling. Choose 31645 when the purpose is therapeutic removal of airway material.
- 31635BronchoscopyForeign body removal
- 31635 is for bronchoscopic removal of a foreign body. 31645 is for therapeutic aspiration, such as clearing secretions or mucus plugs.
- 31641Therapeutic bronchoscopyTumor destruction or stenosis relief
- 31641 describes bronchoscopic treatment of an airway blockage; 31645 describes clearing material by therapeutic aspiration.
31645 billing questions
When is 31646 used instead of 31645?
31645 identifies the initial therapeutic aspiration. 31646 is the companion code for subsequent therapeutic aspiration when performed.
Is airway aspiration the same as bronchoalveolar lavage?
No. Report 31645 for therapeutic removal of obstructing material; 31624 describes bronchoscopy with bronchoalveolar lavage, commonly performed to obtain a lower-airway sample.
Does removing a foreign body belong under 31645?
When the procedure removes a foreign body, compare 31635. 31645 describes therapeutic aspiration, such as clearing secretions or mucus plugs.
Can modifier 50 be reported?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
How does Medicare handle related endoscopies performed together?
Endoscopy family pricing applies when related endoscopies are performed together. The code also has a 0-day global period, which includes same-day preoperative and postoperative care.
Can an assistant, co-surgeon, or surgical team be paid?
Medicare does not pay an assistant at surgery for 31645. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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