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Billing code 31646: Bronchoscopic aspirationMedicare rate & RVUs

Reports a subsequent therapeutic aspiration of airway secretions during the same bronchoscopy session after the initial aspiration service.

CMS RVU26DEffective Oct 1, 2026109 payment localities4.7K Medicare services in 2024

Medicare pays $128.93 for 31646 nationally in a facility.

Medicare rate · 31646

Bronchoscopic aspiration

Swap in your local Medicare rate.

Work RVUs
2.71
Total RVUs
3.86
Global days
000

National rate · 2026

$128.93

Facility setting, before claim adjustments.

See every locality for 31646 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 31646 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 31646 covers

During bronchoscopy, the physician or other qualified practitioner uses suction through a flexible or rigid scope to clear additional secretions or mucus from the tracheobronchial tree. This may be needed when retained secretions or mucus plugging continue to obstruct the airways after an initial therapeutic aspiration. The service is commonly performed by a pulmonologist or thoracic surgeon in a hospital or other facility setting.

Report this code for a subsequent therapeutic aspiration in the same session, with the initial aspiration reported separately using 31645. Document the clinical reason for further airway clearance and the subsequent aspiration performed. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. 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 31646 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

31646 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$121.34
Alaska*Unavailable$172.05
ArizonaUnavailable$126.72
ArkansasUnavailable$120.41
AtlantaUnavailable$131.48
AustinUnavailable$129.79
BakersfieldUnavailable$129.94
Baltimore/Surr. CntysUnavailable$134.66
BeaumontUnavailable$125.64
BrazoriaUnavailable$127.40

31646 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
31646 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 31646 rate is calculated

Each of 31646’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 · 31646

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 2.71Practice expense 0.88Malpractice 0.27

3.8600 adjusted RVUs×$33.4009 conversion factor=$128.93

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 31646

The CMS indicators that decide how 31646 is paid alongside other services.

CMS payment indicators · 31646

Bronchoscopic aspiration

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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

31646 without 51 · national facility

$128.93

Bronchoscopic aspiration

31646-51 · Second procedure: 50%

$64.47

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

31646 compared with similar codes

Compare codes

31646 vs 31645 vs 31635 vs 31641: national Medicare rates

Swap in your local Medicare rate.

  • 31646
    Bronchoscopic aspiration · 2.71 wRVU
    —
  • 31645
    Bronchial aspiration · 2.81 wRVU
    $308.29
  • 31635
    Bronchoscopy · 3.33 wRVU
    $323.99
  • 31641
    Therapeutic bronchoscopy · 4.89 wRVU
    —

How to choose

31645Bronchial aspiration
31645 reports the initial therapeutic aspiration in the bronchoscopy session; 31646 is for a subsequent aspiration in that same session.
31635Bronchoscopy
Choose 31635 when the bronchoscopic service removes a foreign body. 31646 concerns subsequent therapeutic aspiration of airway secretions.
31641Therapeutic bronchoscopy
31641 covers bronchoscopic destruction of tumor or relief of stenosis by specified methods; 31646 reports subsequent therapeutic aspiration.

Codes related to 31646

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

Codes related to 31646
CodeHow it relatesNational office range
Add-on codes
31645Bronchial aspirationReports the initial therapeutic airway aspiration before a subsequent service under 31646.$274.72–$404.62
Used instead
31635BronchoscopyUsed for bronchoscopic removal of a foreign body rather than aspiration of airway secretions.$289.85–$419.37
31641Therapeutic bronchoscopyTreats tumor or stenosis by methods such as laser or cryotherapy, rather than aspirating secretions.No office rate

31646 billing questions

When is 31646 reported instead of 31645?

Use 31645 for the initial therapeutic aspiration during the bronchoscopy session. Report 31646 for a subsequent therapeutic aspiration in that same session.

Does 31646 require 31645 on the claim?

Yes. The initial therapeutic aspiration is reported with 31645; 31646 describes the subsequent aspiration service.

Can routine suctioning during bronchoscopy support 31646?

Document the clinical need for further airway clearance and the subsequent therapeutic aspiration performed. Routine suctioning alone does not establish a subsequent therapeutic service.

Should modifier 50 be appended?

No. The service is not reported bilaterally, and modifier 50 is inappropriate.

How does the 0-day global period affect same-day care?

Same-day preoperative and postoperative care is included in the procedure's global period.

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 31646PPRRVU2026_Oct_nonQPP.csv, line 3,652 (RVU26D)

Open CMS sourceHow we calculate rates

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