Billing code 31646: Bronchoscopic aspirationMedicare rate & RVUs in Guam
Reports a subsequent therapeutic aspiration of airway secretions during the same bronchoscopy session after the initial aspiration service.
CMS doesn’t publish an office rate for 31646 in Guam.
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 9 sections
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.
31646 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $129.16 |
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
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
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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
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%).
31646 compared with similar codes
Compare codes
31646 vs 31645 vs 31635 vs 31641: national Medicare rates
Swap in your local Medicare rate.
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.
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
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