CPT code 32445: Pneumonectomy, extrapleural approach2026 Medicare rate & RVUs in California
Reports an extrapleural pneumonectomy, an extensive operation removing a lung with extrapleural dissection, most often for diffuse malignant pleural disease.
CMS doesn’t publish an office rate for 32445 in California.
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
On this page 9 sections
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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $3,196.03 |
| Chico, CA | Unavailable | $3,153.61 |
| El Centro, CA | Unavailable | $3,156.23 |
| Fresno, CA | Unavailable | $3,153.61 |
| Hanford, CA | Unavailable | $3,153.61 |
| Los Angeles, CA | Unavailable | $3,330.80 |
| Madera, CA | Unavailable | $3,153.61 |
| Marin County, CA | Unavailable | $3,492.72 |
| Merced, CA | Unavailable | $3,153.61 |
| Modesto, CA | Unavailable | $3,153.61 |
| Napa, CA | Unavailable | $3,388.21 |
| Oxnard, CA | Unavailable | $3,281.59 |
| Redding, CA | Unavailable | $3,153.61 |
| Rest of California | Unavailable | $3,153.61 |
| Riverside, CA | Unavailable | $3,321.82 |
| Sacramento, CA | Unavailable | $3,239.48 |
| Salinas, CA | Unavailable | $3,226.32 |
| San Benito County, CA | Unavailable | $3,586.40 |
| San Diego, CA | Unavailable | $3,252.99 |
| San Francisco, CA | Unavailable | $3,474.90 |
| San Luis Obispo, CA | Unavailable | $3,183.37 |
| Santa Clara County, CA | Unavailable | $3,513.56 |
| Santa Cruz, CA | Unavailable | $3,244.29 |
| Santa Maria, CA | Unavailable | $3,224.93 |
| Santa Rosa, CA | Unavailable | $3,271.99 |
| Stockton, CA | Unavailable | $3,153.61 |
| Vallejo, CA | Unavailable | $3,362.53 |
| Visalia, CA | Unavailable | $3,153.61 |
| Yuba City, CA | Unavailable | $3,153.61 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.76/0.14 | Share 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.
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%).
32445 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
Fee sheets
Put 32445 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet