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

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 Virginia, Medicare pays $301.96 for 31645 in the office and $129.92 when it’s performed in a hospital or facility.

$301.96Office (non-facility)
$129.92Hospital or facility
−2.1%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 Virginia
  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 Virginia 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. Virginia pays $301.96. The RVUs are the same everywhere; the geographic indexes change the dollars.

31645 in Virginia vs other payment areas
  1. Virginia · this page$301.96
  2. Los Angeles, CA · California$346.35+$44.39
  3. Washington, DC area · District of Columbia$350.90+$48.94
  4. Miami, FL · Florida$331.50+$29.54
  5. Chicago, IL · Illinois$322.51+$20.55
  6. Manhattan, NY · New York$353.14+$51.18
  7. Alaska · Alaska$364.18+$62.22

Other areas in Virginia 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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 31645 in Virginia
ComponentRVULocality factorAdjusted
Physician work2.81× 1.0002.8100
Practice expense6.13× 0.9836.0258
Malpractice0.29× 0.7060.2047
Total RVUs9.0405
Conversion factor× 33.4009

Office rate, Virginia$301.96

Office: (2.81 × 1 + 6.13 × 0.983 + 0.29 × 0.706) × $33.4009 = $301.96

Facility: (2.81 × 1 + 0.89 × 0.983 + 0.29 × 0.706) × $33.4009 = $129.92

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, Virginia
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.$317.04
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.$280.61

How 31645 has changed in Virginia

31645 · Office / nonfacility

$301.96

Effective 2026-10-01

The base rate is $40.72 higher than on 2025-10-01, moving from $261.24 to $301.96 (15.6%).

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

    $261.24changed to$301.96

    • 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
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $268.43changed to$261.24

    • 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

    $264.05changed to$268.43

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $272.22changed to$264.05

    • 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
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $282.00changed to$272.22

    • 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 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $278.75changed to$282.00

    • 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.

  7. January 1, 2021

    RVU21A

    $269.06changed to$278.75

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.38 changed to 4.90
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $264.39changed to$269.06

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.28 changed to 4.38
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $262.68changed to$264.39

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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $256.75changed to$262.68

    • 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 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $324.83changed to$256.75

    • 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 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $325.95changed to$324.83

    • 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.

  13. July 1, 2015

    RVU15C

    $324.33changed to$325.95

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $316.90changed to$324.33

    • 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 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $323.48changed to$316.90

    • 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 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $323.48

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$301.96$129.92RVU26D
2026-07-01$301.96$129.92RVU26C
2026-04-01$301.96$129.92RVU26B
2026-01-01$301.96$129.92RVU26A
2025-10-01$261.24$137.42RVU25D
2025-07-01$261.24$137.42RVU25C
2025-04-01$261.24$137.42RVU25B
2025-01-01$261.24$137.42RVU25A
2024-10-01$268.43$141.02RVU24D
2024-07-01$268.43$141.02RVU24C
2024-04-01$268.43$141.02RVU24B
2024-03-09$268.43$141.02RVU24AR
2024-01-01$264.05$138.71RVU24A
2023-10-01$272.22$143.06RVU23D
2023-07-01$272.22$143.06RVU23C
2023-04-01$272.22$143.06RVU23B
2023-01-01$272.22$143.06RVU23A
2022-10-01$282.00$147.02RVU22D
2022-07-01$282.00$147.02RVU22C
2022-04-01$282.00$147.02RVU22B
2022-01-01$282.00$147.02RVU22A
2021-10-01$278.75$147.86RVU21D
2021-07-01$278.75$147.86RVU21C
2021-04-01$278.75$147.86RVU21B
2021-01-01$278.75$147.86RVU21A
2020-10-01$269.06$151.39RVU20D
2020-07-01$269.06$151.39RVU20C
2020-04-01$269.06$151.39RVU20B
2020-01-01$269.06$151.39RVU20A
2019-10-01$264.39$150.32RVU19D
2019-07-01$264.39$150.32RVU19C
2019-04-01$264.39$150.32RVU19B
2019-01-01$264.39$150.32RVU19A
2018-10-01$262.68$150.87RVU18D
2018-07-01$262.68$150.87RVU18C
2018-04-01$262.68$150.87RVU18B
2018-01-01$262.68$150.87RVU18AR1
2017-10-01$256.75$152.82RVU17D
2017-07-01$256.75$152.82RVU17C
2017-04-01$256.75$152.82RVU17B
2017-01-01$256.75$152.82RVU17A
2016-10-01$324.83$163.99RVU16D
2016-07-01$324.83$163.99RVU16C
2016-04-01$324.83$163.99RVU16B
2016-01-01$324.83$163.99RVU16A
2015-10-01$325.95$164.88RVU15D
2015-07-01$325.95$164.88RVU15C
2015-04-01$324.33$164.06RVU15B
2015-01-01$324.33$164.06RVU15A
2014-10-01$316.90$163.83RVU14D
2014-07-01$316.90$163.83RVU14C
2014-04-01$316.90$163.83RVU14B
2014-01-01$316.90$163.83RVU14A
2013-10-01$323.48$159.60RVU13D
2013-07-01$323.48$159.60RVU13C
2013-04-01$323.48$159.60RVU13B
2013-01-01$323.48$159.60RVU13AR

Price 31645 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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