CPT code 32561: Pleural fibrinolysis, initial day2026 Medicare rate & RVUs in Missouri
Reports initial-day instillation of a fibrinolytic through a chest tube or catheter to help clear a loculated pleural fluid collection.
Medicare pays $94.07–$98.78 for 32561 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 32561 covers
A physician or other qualified practitioner instills a fibrinolytic agent, such as alteplase, through a chest tube or pleural catheter to help break down fibrin in a loculated pleural collection. This treatment may be used for a complex effusion or empyema when fluid is divided by fibrinous septations. It is performed in settings where the patient can receive care through the pleural drain; the code describes the instillation, not placement of the tube or catheter.
Report 32561 for the initial treatment day. For a later treatment day, use the subsequent-day code 32562 rather than reporting another initial-day service. Documentation should identify the pleural indication, the fibrinolytic administered, the catheter route, and the treatment date. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued is paid in full and the others at 50%. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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 32561 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$94.07 to $98.78
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $97.99 | $59.42 |
| Metropolitan St. Louis, MO | $98.78 | $59.67 |
| Rest of Missouri | $94.07 | $58.65 |
How the 32561 rate is calculated
Each of 32561’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 · 32561
RVUs × geographic indexes × conversion factor
Work1.36
1.36 RVUs× 1.000 GPCI
Practice expense1.52
1.52 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
3.0300
Conversion factor
$33.4009
Medicare rate
$101.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 32561
The CMS indicators that decide how 32561 is paid alongside other services.
CMS payment indicators · 32561
Pleural fibrinolysis, initial day
| 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) | 2 | Paid. |
| 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
32561 without 51 · national office
$101.20
Pleural fibrinolysis, initial day
32561-51 · Second procedure: 50%
$50.60
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%).
32561 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 32562Pleural fibrinolysisSubsequent day
- 32561 identifies the initial treatment day; 32562 is for a subsequent treatment day.
- 32560Chemical pleurodesisVia chest tube or catheter
- 32560 is pleurodesis treatment intended to create pleural adhesion. 32561 instills a fibrinolytic to break down fibrin in a pleural collection.
- 32555ThoracentesisWith imaging guidance
- 32555 reports image-guided aspiration of pleural fluid. 32561 reports fibrinolytic instillation through a chest tube or catheter.
32561 billing questions
When should 32561 be used instead of 32562?
Use 32561 for the initial day of pleural fibrinolytic treatment. Use 32562 for treatment on a subsequent day.
Does 32561 include placing the chest tube?
No. It reports fibrinolytic instillation through a chest tube or catheter, not insertion of that access device.
What should the record support?
Document the pleural condition being treated, the fibrinolytic agent, its administration through the drain, and whether this is the initial or a subsequent treatment day.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 0-day global period affect billing?
Same-day preoperative and postoperative care is included in the procedure. Care on a later date is outside that 0-day global period.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code.
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
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