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CPT code 32445: Pneumonectomy, extrapleural approach2026 Medicare rate & RVUs

Reports an extrapleural pneumonectomy, an extensive operation removing a lung with extrapleural dissection, most often for diffuse malignant pleural disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $3,295.00 for 32445 nationally in a facility.

Medicare rate · 32445

Pneumonectomy, extrapleural approach

Office or facility?

Work RVUs
62.24
Total RVUs
98.65
Global days
090

National rate · 2026

$3,295.00

Facility setting, before claim adjustments.

See every locality for 32445 →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.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 32445 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 32445 covers

This code describes an extrapleural pneumonectomy: removal of an entire lung through dissection outside the pleural lining. Thoracic surgeons most often perform it in a hospital operating room for extensive pleural malignancy, particularly diffuse malignant pleural mesothelioma. The operative report should establish that the surgeon performed an extrapleural pneumonectomy, not simply a conventional pneumonectomy with pleural dissection.

Select the code from the documented operation and extent of resection; a complete lung removal alone is not enough to establish the extrapleural approach. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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 32445 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

32445 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,981.05
AlaskaUnavailable$4,144.12
ArizonaUnavailable$3,198.08
ArkansasUnavailable$2,943.25
Atlanta, GAUnavailable$3,417.64
Austin, TXUnavailable$3,279.55
Bakersfield, CAUnavailable$3,196.03
Baltimore area, MDUnavailable$3,502.98
Beaumont, TXUnavailable$3,195.50
Brazoria, TXUnavailable$3,190.11

32445 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
32445 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 32445 rate is calculated

Each of 32445’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 · 32445

RVUs × geographic indexes × conversion factor

Office or facility?

Work62.24

62.24 RVUs× 1.000 GPCI

Practice expense20.72

20.72 RVUs× 1.000 GPCI

Malpractice15.69

15.69 RVUs× 1.000 GPCI

Adjusted RVUs

98.6500

Conversion factor

$33.4009

Medicare rate

$3,295.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 32445

32445 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 32445

Pneumonectomy, extrapleural approach

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are 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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.76/0.14Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 32445

Pneumonectomy, extrapleural approach

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

32445 without 51 · national facility

$3,295.00

Pneumonectomy, extrapleural approach

32445-51 · Second procedure: 50%

$1,647.50

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

32445 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 32445

    Pneumonectomy, extrapleural approach62.24 wRVU

    Not priced

  • 32440

    Pneumonectomy, entire lung removed26.6 wRVU

    Not priced

  • 32442

    Pneumonectomy, sleeve airway resection55.06 wRVU

    Not priced

  • 32480

    Lung resection, single-lobe lobectomy25.17 wRVU

    Not priced

How to choose

32440PneumonectomyEntire lung removed
Use 32445 for an extrapleural pneumonectomy. Use 32440 for pneumonectomy when the operative documentation does not establish the extrapleural procedure.
32442PneumonectomySleeve airway resection
Code 32442 describes sleeve pneumonectomy, distinguished by the sleeve resection technique. Code 32445 identifies the extrapleural pneumonectomy.
32480Lung resectionSingle-lobe lobectomy
Code 32480 is for partial lung removal. Code 32445 is for an extrapleural operation removing an entire lung.

Codes related to 32445

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

Codes related to 32445
CodeHow it relatesNational office range
Used instead
32440Pneumonectomy, entire lung removedReports pneumonectomy when the operation is not documented as extrapleural.No office rate
32442Pneumonectomy, sleeve airway resectionDescribes sleeve pneumonectomy, a distinct pneumonectomy technique.No office rate
32480Lung resection, single-lobe lobectomyUsed for partial lung removal rather than extrapleural removal of an entire lung.No office rate
32482Bilobectomy, two right lung lobesDescribes removal of two lobes, a lesser lung resection.No office rate
32484Lung resection, anatomic segmentectomyDescribes segmental lung removal rather than removal of an entire lung.No office rate

32445 billing questions

How does this differ from 32440?

Report 32445 when the operative documentation supports an extrapleural pneumonectomy. Code 32440 describes pneumonectomy without that extrapleural distinction.

What documentation supports 32445?

The operative report should identify the extrapleural pneumonectomy and describe the dissection and lung removal. A diagnosis of pleural malignancy alone does not establish the procedure performed.

Can modifier 50 be used for bilateral surgery?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

How does the global period affect postoperative billing?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.

What happens when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.

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 32445PPRRVU2026_Oct_nonQPP.csv, line 3,714 (RVU26D)

Open CMS sourceHow we calculate rates

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