CPT code 32606: Thoracoscopy biopsy, mediastinal mass2026 Medicare rate & RVUs in Puerto Rico
Report this service when a surgeon uses thoracoscopy to obtain biopsy tissue from a mediastinal mass or lesion for diagnostic evaluation.
In Puerto Rico, Medicare pays $428.46 for 32606 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 32606 nationwide
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 11 sections
What 32606 covers
A thoracic surgeon uses a scope and instruments introduced through chest-wall ports to inspect the chest and obtain tissue from a mediastinal mass or lesion. The specimen may help evaluate an abnormality seen on imaging or clarify a suspected mediastinal disease. The service is generally performed in an operating room with the patient under anesthesia; it is not the code for sampling a lung nodule, pulmonary infiltrate, pleura, or pericardial sac.
Select the code according to the sampled target and thoracoscopic approach, and document the mediastinal site, the biopsy performed, and the operative findings. Biopsies of multiple portions of a mediastinal mass during the same session are reported as the procedure, not as separate units for each specimen. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; 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.
How Puerto Rico compares for 32606
Across 109 of 109 payment localities, the facility rate for 32606 runs from $377.50 in Wisconsin to $540.04 in Alaska. Puerto Rico pays $428.46. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$428.46
- Los Angeles, CA · California$432.62+$4.16
- Washington, DC area · District of Columbia$466.48+$38.02
- Miami, FL · Florida$536.79+$108.33
- Chicago, IL · Illinois$519.55+$91.09
- Manhattan, NY · New York$500.21+$71.75
- Alaska · Alaska$540.04+$111.58
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $387.96 |
| ArkansasArkansas | — | $383.08 |
| ArizonaArizona | — | $415.98 |
| Bakersfield, CACalifornia | — | $415.29 |
| Chico, CACalifornia | — | $409.74 |
| El Centro, CACalifornia | — | $410.09 |
| Fresno, CACalifornia | — | $409.74 |
| Hanford, CACalifornia | — | $409.74 |
| Madera, CACalifornia | — | $409.74 |
| Merced, CACalifornia | — | $409.74 |
| Modesto, CACalifornia | — | $409.74 |
| Napa, CACalifornia | — | $439.67 |
| Oxnard, CACalifornia | — | $426.18 |
| Redding, CACalifornia | — | $409.74 |
| Rest of CaliforniaCalifornia | — | $409.74 |
| Riverside, CACalifornia | — | $431.72 |
| Sacramento, CACalifornia | — | $420.75 |
| Salinas, CACalifornia | — | $419.04 |
| San Diego, CACalifornia | — | $422.39 |
| Marin County, CACalifornia | — | $453.05 |
| San Francisco, CACalifornia | — | $450.72 |
| San Benito County, CACalifornia | — | $465.20 |
| Santa Clara County, CACalifornia | — | $455.68 |
| San Luis Obispo, CACalifornia | — | $413.48 |
| Santa Cruz, CACalifornia | — | $421.17 |
| Santa Maria, CACalifornia | — | $418.83 |
| Santa Rosa, CACalifornia | — | $424.76 |
| Stockton, CACalifornia | — | $409.74 |
| Vallejo, CACalifornia | — | $436.32 |
| Visalia, CACalifornia | — | $409.74 |
| Yuba City, CACalifornia | — | $409.74 |
| ColoradoColorado | — | $422.37 |
| ConnecticutConnecticut | — | $455.06 |
| DelawareDelaware | — | $421.94 |
| Fort Lauderdale, FLFlorida | — | $484.99 |
| Rest of FloridaFlorida | — | $459.15 |
| Atlanta, GAGeorgia | — | $444.51 |
| Rest of GeorgiaGeorgia | — | $432.30 |
| Hawaii, Guam, HIHawaii | — | $411.60 |
| IowaIowa | — | $379.86 |
| IdahoIdaho | — | $385.50 |
| East St. Louis, ILIllinois | — | $491.02 |
| Rest of IllinoisIllinois | — | $459.53 |
| Suburban Chicago, ILIllinois | — | $485.65 |
| IndianaIndiana | — | $387.00 |
| KansasKansas | — | $386.23 |
| KentuckyKentucky | — | $413.07 |
| New Orleans, LALouisiana | — | $432.72 |
| Rest of LouisianaLouisiana | — | $415.67 |
| Metropolitan Boston, MAMassachusetts | — | $449.05 |
| Rest of MassachusettsMassachusetts | — | $423.61 |
| Baltimore area, MDMaryland | — | $455.47 |
| Rest of MarylandMaryland | — | $426.69 |
| Rest of MaineMaine | — | $395.70 |
| Southern Maine, MEMaine | — | $402.49 |
| Detroit, MIMichigan | — | $472.47 |
| Rest of MichiganMichigan | — | $429.81 |
| MinnesotaMinnesota | — | $382.85 |
| Metropolitan Kansas City, MOMissouri | — | $421.66 |
| Metropolitan St. Louis, MOMissouri | — | $424.50 |
| Rest of MissouriMissouri | — | $414.77 |
| MississippiMississippi | — | $398.59 |
| MontanaMontana | — | $428.40 |
| North CarolinaNorth Carolina | — | $398.00 |
| North DakotaNorth Dakota | — | $387.86 |
| NebraskaNebraska | — | $379.26 |
| New HampshireNew Hampshire | — | $423.54 |
| Northern New JerseyNew Jersey | — | $464.30 |
| Rest of New JerseyNew Jersey | — | $454.09 |
| New MexicoNew Mexico | — | $435.09 |
| NevadaNevada | — | $417.19 |
| NYC suburbs and Long Island, NYNew York | — | $521.11 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $463.46 |
| Queens, NYNew York | — | $492.09 |
| Rest of New YorkNew York | — | $403.86 |
| OhioOhio | — | $421.53 |
| OklahomaOklahoma | — | $403.97 |
| Portland, OROregon | — | $425.02 |
| Rest of OregonOregon | — | $407.85 |
| Metropolitan Philadelphia, PAPennsylvania | — | $450.23 |
| Rest of PennsylvaniaPennsylvania | — | $417.65 |
| Rhode IslandRhode Island | — | $429.20 |
| South CarolinaSouth Carolina | — | $411.66 |
| South DakotaSouth Dakota | — | $383.07 |
| TennesseeTennessee | — | $388.93 |
| Austin, TXTexas | — | $426.31 |
| Beaumont, TXTexas | — | $415.86 |
| Brazoria, TXTexas | — | $414.87 |
| Dallas, TXTexas | — | $420.92 |
| Fort Worth, TXTexas | — | $420.94 |
| Galveston, TXTexas | — | $418.33 |
| Houston, TXTexas | — | $455.86 |
| Rest of TexasTexas | — | $417.46 |
| UtahUtah | — | $416.34 |
| VirginiaVirginia | — | $406.93 |
| Virgin Islands, VIUnited States Virgin Islands | — | $428.46 |
| VermontVermont | — | $393.84 |
| Rest of WashingtonWashington | — | $420.32 |
| King County, WAWashington | — | $449.38 |
| WisconsinWisconsin | — | $377.50 |
| West VirginiaWest Virginia | — | $446.67 |
| WyomingWyoming | — | $410.73 |
32606 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 32606 rate is calculated
Each of 32606’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 · 32606
RVUs × geographic indexes × conversion factor
Work8.18
8.18 RVUs× 1.000 GPCI
Practice expense2.60
2.60 RVUs× 1.000 GPCI
Malpractice2.05
2.05 RVUs× 1.000 GPCI
Adjusted RVUs
12.8300
Conversion factor
$33.4009
Medicare rate
$428.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
3,742
- Code
- 32606
- Physician work
- 8.18
- Practice expense
- 2.60
- Malpractice
- 2.05
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.18 | × 1.000 | 8.1800 |
| Practice expense | 2.60 | × 1.011 | 2.6286 |
| Malpractice | 2.05 | × 0.985 | 2.0192 |
| Total RVUs | 12.8278 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$428.46
Facility: (8.18 × 1 + 2.6 × 1.011 + 2.05 × 0.985) × $33.4009 = $428.46
Payment rules and modifiers for 32606
The CMS indicators that decide how 32606 is paid alongside other services.
CMS payment indicators · 32606
Thoracoscopy biopsy, mediastinal mass
| 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) | 0 | Not paid without supporting documentation. |
| 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
32606 without 51 · national facility
$428.53
Thoracoscopy biopsy, mediastinal mass
32606-51 · Second procedure: 50%
$214.27
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%).
How 32606 has changed in Puerto Rico
32606 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $428.46 | RVU26D |
| 2026-07-01 | Not available in this setting | $428.46 | RVU26C |
| 2026-04-01 | Not available in this setting | $428.46 | RVU26B |
| 2026-01-01 | Not available in this setting | $428.46 | RVU26A |
| 2025-10-01 | Not available in this setting | $441.72 | RVU25D |
| 2025-07-01 | Not available in this setting | $441.72 | RVU25C |
| 2025-04-01 | Not available in this setting | $441.72 | RVU25B |
| 2025-01-01 | Not available in this setting | $441.72 | RVU25A |
| 2024-10-01 | Not available in this setting | $451.87 | RVU24D |
| 2024-07-01 | Not available in this setting | $451.87 | RVU24C |
| 2024-04-01 | Not available in this setting | $451.87 | RVU24B |
| 2024-03-09 | Not available in this setting | $451.87 | RVU24AR |
| 2024-01-01 | Not available in this setting | $444.50 | RVU24A |
| 2023-10-01 | Not available in this setting | $458.26 | RVU23D |
| 2023-07-01 | Not available in this setting | $458.49 | RVU23C |
| 2023-04-01 | Not available in this setting | $458.49 | RVU23B |
| 2023-01-01 | Not available in this setting | $458.49 | RVU23A |
| 2022-10-01 | Not available in this setting | $468.48 | RVU22D |
| 2022-07-01 | Not available in this setting | $468.48 | RVU22C |
| 2022-04-01 | Not available in this setting | $468.48 | RVU22B |
| 2022-01-01 | Not available in this setting | $468.48 | RVU22A |
| 2021-10-01 | Not available in this setting | $469.95 | RVU21D |
| 2021-07-01 | Not available in this setting | $469.95 | RVU21C |
| 2021-04-01 | Not available in this setting | $469.95 | RVU21B |
| 2021-01-01 | Not available in this setting | $469.95 | RVU21A |
| 2020-10-01 | Not available in this setting | $482.94 | RVU20D |
| 2020-07-01 | Not available in this setting | $482.94 | RVU20C |
| 2020-04-01 | Not available in this setting | $482.94 | RVU20B |
| 2020-01-01 | Not available in this setting | $482.94 | RVU20A |
| 2019-10-01 | Not available in this setting | $481.20 | RVU19D |
| 2019-07-01 | Not available in this setting | $481.20 | RVU19C |
| 2019-04-01 | Not available in this setting | $481.20 | RVU19B |
| 2019-01-01 | Not available in this setting | $481.20 | RVU19A |
| 2018-10-01 | Not available in this setting | $481.41 | RVU18D |
| 2018-07-01 | Not available in this setting | $481.41 | RVU18C |
| 2018-04-01 | Not available in this setting | $481.41 | RVU18B |
| 2018-01-01 | Not available in this setting | $481.41 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $440.58 | RVU17D |
| 2017-07-01 | Not available in this setting | $440.58 | RVU17C |
| 2017-04-01 | Not available in this setting | $440.58 | RVU17B |
| 2017-01-01 | Not available in this setting | $440.58 | RVU17A |
| 2016-10-01 | Not available in this setting | $399.65 | RVU16D |
| 2016-07-01 | Not available in this setting | $399.65 | RVU16C |
| 2016-04-01 | Not available in this setting | $399.65 | RVU16B |
| 2016-01-01 | Not available in this setting | $399.65 | RVU16A |
| 2015-10-01 | Not available in this setting | $401.07 | RVU15D |
| 2015-07-01 | Not available in this setting | $401.07 | RVU15C |
| 2015-04-01 | Not available in this setting | $399.08 | RVU15B |
| 2015-01-01 | Not available in this setting | $399.08 | RVU15A |
| 2014-10-01 | Not available in this setting | $396.60 | RVU14D |
| 2014-07-01 | Not available in this setting | $396.60 | RVU14C |
| 2014-04-01 | Not available in this setting | $396.60 | RVU14B |
| 2014-01-01 | Not available in this setting | $396.60 | RVU14A |
| 2013-10-01 | Not available in this setting | $382.31 | RVU13D |
| 2013-07-01 | Not available in this setting | $382.31 | RVU13C |
| 2013-04-01 | Not available in this setting | $382.31 | RVU13B |
| 2013-01-01 | Not available in this setting | $382.31 | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
32606 billing questions
How is this different from a thoracoscopic lung biopsy code?
Use this code when the sampled target is a mediastinal mass or lesion. Codes 32607 and 32608 describe biopsy of a pulmonary infiltrate and lung nodule, respectively.
Can multiple mediastinal biopsy specimens be billed as multiple units?
The service covers biopsy of the mediastinal target, including multiple biopsy samples obtained during the same session. Do not count each specimen as a separate unit.
Is a separate diagnostic thoracoscopy also reported?
When the thoracoscopy includes biopsy of the mediastinal mass, report the biopsy service rather than separately reporting diagnostic thoracoscopy for the same operative inspection.
Can modifier 50 be used when both sides are sampled?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 is not appropriate.
What documentation supports this code?
The operative report should identify the mediastinal target, confirm that the surgeon obtained biopsy tissue, and describe the thoracoscopic approach.
When is an assistant-at-surgery payable?
CMS payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.
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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