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CPT code 32609: Pleural biopsy, thoracoscopic approach2026 Medicare rate & RVUs

Report this service when a surgeon uses thoracoscopy to obtain pleural tissue, such as for evaluation of unexplained effusion or abnormal pleura.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.4K Medicare services in 2024

Medicare pays $238.82 for 32609 nationally in a facility.

Medicare rate · 32609

Pleural biopsy, thoracoscopic approach

Office or facility?

Work RVUs
4.47
Total RVUs
7.15
Global days
000

National rate · 2026

$238.82

Facility setting, before claim adjustments.

See every locality for 32609 →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 32609 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 32609 covers

A thoracic surgeon uses a scope passed through the chest wall to inspect the pleural space and collect tissue from the pleura. This is commonly performed in a hospital operating room when imaging or prior evaluation shows pleural thickening, nodules, or an unexplained effusion and tissue is needed to investigate possible malignancy, infection, or another pleural disorder. The specimen is sent for pathologic examination.

Report the code when pleural tissue is sampled; the scope inspection needed to locate and obtain that sample is part of the service, rather than a separate diagnostic thoracoscopy. The operative report should identify the pleural target and document that tissue was collected. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. 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.

Where 32609 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

32609 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$217.82
AlaskaUnavailable$302.98
ArizonaUnavailable$232.46
ArkansasUnavailable$215.28
Atlanta, GAUnavailable$246.57
Austin, TXUnavailable$238.85
Bakersfield, CAUnavailable$234.79
Baltimore area, MDUnavailable$252.94
Beaumont, TXUnavailable$231.36
Brazoria, TXUnavailable$232.51

32609 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
32609 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 32609 rate is calculated

Each of 32609’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 · 32609

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.47

4.47 RVUs× 1.000 GPCI

Practice expense1.73

1.73 RVUs× 1.000 GPCI

Malpractice0.95

0.95 RVUs× 1.000 GPCI

Adjusted RVUs

7.1500

Conversion factor

$33.4009

Medicare rate

$238.82

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

Payment rules and modifiers for 32609

The CMS indicators that decide how 32609 is paid alongside other services.

CMS payment indicators · 32609

Pleural biopsy, thoracoscopic approach

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

32609 without 51 · national facility

$238.82

Pleural biopsy, thoracoscopic approach

32609-51 · Second procedure: 50%

$119.41

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

32609 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 32609

    Pleural biopsy, thoracoscopic approach4.47 wRVU

    Not priced

  • 32601

    Diagnostic thoracoscopy, without biopsy5.36 wRVU

    Not priced

  • 32606

    Thoracoscopy biopsy, mediastinal mass8.18 wRVU

    Not priced

  • 32607

    Lung biopsy, infiltrate, thoracoscopic5.36 wRVU

    Not priced

  • 32608

    Thoracoscopic biopsy, pulmonary nodule or mass6.67 wRVU

    Not priced

How to choose

32601Diagnostic thoracoscopyWithout biopsy
Choose 32609 when pleural tissue is sampled. Choose 32601 for diagnostic thoracoscopy when no pleural biopsy is performed.
32606Thoracoscopy biopsyMediastinal mass
32609 covers sampling pleura; 32606 is for thoracoscopic biopsy of the mediastinal space.
32607Lung biopsyInfiltrate, thoracoscopic
32609 is selected for a pleural specimen. 32607 applies when the sampled target is a pulmonary infiltrate.
32608Thoracoscopic biopsyPulmonary nodule or mass
Use 32609 for pleural tissue and 32608 when thoracoscopic biopsy targets a pulmonary nodule.

Codes related to 32609

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

Codes related to 32609
CodeHow it relatesNational office range
Used instead
32601Diagnostic thoracoscopy, without biopsyDiagnostic thoracoscopy without pleural biopsy.No office rate
32606Thoracoscopy biopsy, mediastinal massBiopsy targets the mediastinal space rather than pleura.No office rate
32607Lung biopsy, infiltrate, thoracoscopicBiopsy targets a pulmonary infiltrate rather than pleura.No office rate
32608Thoracoscopic biopsy, pulmonary nodule or massBiopsy targets a pulmonary nodule rather than pleura.No office rate
Often billed with
32650Pleurodesis, thoracoscopic approachThoracoscopic pleurodesis may be performed during the same session as pleural biopsy.No office rate

32609 billing questions

When should this be chosen over diagnostic thoracoscopy?

Use this code when pleural tissue is obtained. A diagnostic thoracoscopy without pleural biopsy is represented by 32601.

Can diagnostic thoracoscopy also be reported?

Do not separately report 32601 for the visualization used to locate and obtain the pleural biopsy; that inspection is part of this service.

Can pleurodesis be performed and reported in the same session?

Pleurodesis may be performed during the same thoracoscopy as pleural biopsy. When both procedures are reported, CMS applies the multiple-procedure reduction to the lower-valued procedure or procedures.

Should modifier 50 be appended for bilateral pleural sampling?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

What documentation supports reporting the biopsy?

The operative report should establish that the sampled tissue was pleura, describe the target or abnormality, and document that a specimen was obtained.

When is assistant-at-surgery payment available?

CMS allows assistant-at-surgery payment only when the record documents 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
RVUs for 32609PPRRVU2026_Oct_nonQPP.csv, line 3,745 (RVU26D)

Open CMS sourceHow we calculate rates

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