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CPT code 31645: Bronchial aspiration, initial therapeutic aspiration2026 Medicare rate & RVUs in Puerto Rico

Reports initial bronchoscopic therapeutic aspiration to clear airway secretions, mucus plugs, or other material obstructing the tracheobronchial tree.

CMS RVU26DEffective Oct 1, 2026One payment locality42.4K Medicare services in 2024

In Puerto Rico, Medicare pays $310.40 for 31645 in the office and $133.45 when it’s performed in a hospital or facility.

$310.40Office (non-facility)
$133.45Hospital or facility
+0.7%vs the national office rate ($308.29)

Check a contract rate as a % of Medicare · 31645 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 31645 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 31645 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Puerto Rico compares for 31645

Across 109 of 109 payment localities, the office rate for 31645 runs from $274.72 in Arkansas to $404.62 in San Benito County, CA. Puerto Rico pays $310.40. The RVUs are the same everywhere; the geographic indexes change the dollars.

31645 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$310.40
  2. Los Angeles, CA · California$346.35+$35.95
  3. Washington, DC area · District of Columbia$350.90+$40.50
  4. Miami, FL · Florida$331.50+$21.10
  5. Chicago, IL · Illinois$322.51+$12.11
  6. Manhattan, NY · New York$353.14+$42.74
  7. Alaska · Alaska$364.18+$53.78

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

31645 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$278.49$125.35
ArkansasArkansas$274.72$124.38
ArizonaArizona$300.55$130.95
Bakersfield, CACalifornia$325.94$134.12
Chico, CACalifornia$325.05$133.22
El Centro, CACalifornia$325.10$133.27
Fresno, CACalifornia$325.05$133.22
Hanford, CACalifornia$325.05$133.22

31645 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
31645 office rate range by state
State / territoryOffice rate rangeLocalities
AK$364.181
AL$278.491
AR$274.721
AZ$300.551
CA$325.05–$404.6229
CO$320.401
CT$327.971
DC$350.901
DE$305.321
FL$304.15–$331.503
GA$288.04–$313.792
GU$332.261
HI$332.261
IA$285.051
ID$286.811
IL$295.93–$322.514
IN$288.371
KS$283.831
KY$284.741
LA$284.34–$297.532
MA$318.68–$350.792
MD$310.89–$350.903
ME$288.25–$302.872
MI$291.73–$307.772
MN$307.411
MO$279.78–$298.483
MS$277.301
MT$308.271
NC$291.081
ND$302.541
NE$286.501
NH$315.471
NJ$331.82–$347.622
NM$293.241
NV$306.881
NY$295.18–$361.305
OH$290.551
OK$284.221
OR$304.59–$330.042
PA$290.97–$320.242
PR$310.401
RI$315.781
SC$291.281
SD$301.861
TN$285.171
TX$289.18–$319.258
UT$295.021
VA$301.96–$350.902
VI$310.401
VT$301.461
WA$318.05–$357.692
WI$292.991
WV$285.641
WY$305.771

See 31645 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,651

Code
31645
Physician work
2.81
Practice expense
6.13
Malpractice
0.29

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 31645 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.81× 1.0002.8100
Practice expense6.13× 1.0116.1974
Malpractice0.29× 0.9850.2856
Total RVUs9.2931
Conversion factor× 33.4009

Office rate, Puerto Rico$310.40

Office: (2.81 × 1 + 6.13 × 1.011 + 0.29 × 0.985) × $33.4009 = $310.40

Facility: (2.81 × 1 + 0.89 × 1.011 + 0.29 × 0.985) × $33.4009 = $133.45

Open 31645 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

Codes related to 31645

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 31645
CodeHow it relatesOffice range, Puerto Rico
Add-on codes
31646Bronchoscopic aspiration, subsequent aspirationAdd-on companion for subsequent therapeutic aspiration of the tracheobronchial tree.No office rate
Used instead
31635Bronchoscopy, foreign body removalUsed for bronchoscopic foreign-body removal rather than aspiration of secretions.$326.02
31641Therapeutic bronchoscopy, tumor destruction or stenosis reliefTreats an airway blockage bronchoscopically rather than clearing it by therapeutic aspiration.No office rate
31624Bronchoscopy, bronchoalveolar lavageBronchoalveolar lavage is used for lavage and sampling, not therapeutic airway clearance.$288.25

How 31645 has changed in Puerto Rico

31645 · Office / nonfacility

$310.40

Effective 2026-10-01

The base rate is $43.53 higher than on 2025-10-01, moving from $266.87 to $310.40 (16.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $266.87changed to$310.40

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.88 changed to 2.81
    • Practice expense RVU 5.06 changed to 6.13
    • Malpractice RVU 0.28 changed to 0.29
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $274.29changed to$266.87

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.04 changed to 5.06
    • Malpractice RVU 0.29 changed to 0.28

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $269.81changed to$274.29

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $276.71changed to$269.81

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.98 changed to 5.04
    • Malpractice RVU 0.27 changed to 0.29
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $275.50changed to$276.71

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $285.05changed to$275.50

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.07 changed to 4.98
    • Malpractice RVU 0.25 changed to 0.27
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $281.78changed to$285.05

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.90 changed to 5.07
    • Malpractice RVU 0.26 changed to 0.25

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $272.55changed to$281.78

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.38 changed to 4.90
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $268.40changed to$272.55

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.28 changed to 4.38
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $266.65changed to$268.40

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.24 changed to 4.28

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $235.77changed to$266.65

    • Conversion factor 35.8887 changed to 35.9996
    • Work RVU 2.91 changed to 2.88
    • Practice expense RVU 4.08 changed to 4.24
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $261.98changed to$235.77

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 3.16 changed to 2.91
    • Practice expense RVU 5.78 changed to 4.08
    • Malpractice RVU 0.28 changed to 0.26
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $262.78changed to$261.98

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.77 changed to 5.78
    • Malpractice RVU 0.29 changed to 0.28

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $261.47changed to$262.78

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $254.24changed to$261.47

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.58 changed to 5.77
    • Malpractice RVU 0.28 changed to 0.29
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $254.83changed to$254.24

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.28 changed to 5.58
    • Malpractice RVU 0.29 changed to 0.28
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $254.83

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$310.40$133.45RVU26D
2026-07-01$310.40$133.45RVU26C
2026-04-01$310.40$133.45RVU26B
2026-01-01$310.40$133.45RVU26A
2025-10-01$266.87$140.16RVU25D
2025-07-01$266.87$140.16RVU25C
2025-04-01$266.87$140.16RVU25B
2025-01-01$266.87$140.16RVU25A
2024-10-01$274.29$143.90RVU24D
2024-07-01$274.29$143.90RVU24C
2024-04-01$274.29$143.90RVU24B
2024-03-09$274.29$143.90RVU24AR
2024-01-01$269.81$141.55RVU24A
2023-10-01$276.71$145.20RVU23D
2023-07-01$275.50$145.04RVU23C
2023-04-01$275.50$145.04RVU23B
2023-01-01$275.50$145.04RVU23A
2022-10-01$285.05$148.31RVU22D
2022-07-01$285.05$148.31RVU22C
2022-04-01$285.05$148.31RVU22B
2022-01-01$285.05$148.31RVU22A
2021-10-01$281.78$149.18RVU21D
2021-07-01$281.78$149.18RVU21C
2021-04-01$281.78$149.18RVU21B
2021-01-01$281.78$149.18RVU21A
2020-10-01$272.55$152.86RVU20D
2020-07-01$272.55$152.86RVU20C
2020-04-01$272.55$152.86RVU20B
2020-01-01$272.55$152.86RVU20A
2019-10-01$268.40$151.90RVU19D
2019-07-01$268.40$151.90RVU19C
2019-04-01$268.40$151.90RVU19B
2019-01-01$268.40$151.90RVU19A
2018-10-01$266.65$152.46RVU18D
2018-07-01$266.65$152.46RVU18C
2018-04-01$266.65$152.46RVU18B
2018-01-01$266.65$152.46RVU18AR1
2017-10-01$235.77$145.45RVU17D
2017-07-01$235.77$145.45RVU17C
2017-04-01$235.77$145.45RVU17B
2017-01-01$235.77$145.45RVU17A
2016-10-01$261.98$146.62RVU16D
2016-07-01$261.98$146.62RVU16C
2016-04-01$261.98$146.62RVU16B
2016-01-01$261.98$146.62RVU16A
2015-10-01$262.78$147.26RVU15D
2015-07-01$262.78$147.26RVU15C
2015-04-01$261.47$146.52RVU15B
2015-01-01$261.47$146.52RVU15A
2014-10-01$254.24$146.16RVU14D
2014-07-01$254.24$146.16RVU14C
2014-04-01$254.24$146.16RVU14B
2014-01-01$254.24$146.16RVU14A
2013-10-01$254.83$141.11RVU13D
2013-07-01$254.83$141.11RVU13C
2013-04-01$254.83$141.11RVU13B
2013-01-01$254.83$141.11RVU13AR

Price 31645 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 31645PPRRVU2026_Oct_nonQPP.csv, line 3,651 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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