CPT code 32609: Pleural biopsy, thoracoscopic approach2026 Medicare rate & RVUs in Arkansas
Report this service when a surgeon uses thoracoscopy to obtain pleural tissue, such as for evaluation of unexplained effusion or abnormal pleura.
In Arkansas, Medicare pays $215.28 for 32609 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 32609 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 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.
How Arkansas compares for 32609
Across 109 of 109 payment localities, the facility rate for 32609 runs from $214.43 in Wisconsin to $302.98 in Alaska. Arkansas pays $215.28. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Arkansas · this page$215.28
- Los Angeles, CA · California$244.85+$29.57
- Washington, DC area · District of Columbia$260.75+$45.47
- Miami, FL · Florida$289.70+$74.42
- Chicago, IL · Illinois$281.24+$65.96
- Manhattan, NY · New York$276.33+$61.05
- Alaska · Alaska$302.98+$87.70
Other areas in Arkansas first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $217.82 |
| ArizonaArizona | — | $232.46 |
| Bakersfield, CACalifornia | — | $234.79 |
| Chico, CACalifornia | — | $232.18 |
| El Centro, CACalifornia | — | $232.34 |
| Fresno, CACalifornia | — | $232.18 |
| Hanford, CACalifornia | — | $232.18 |
| Madera, CACalifornia | — | $232.18 |
| Merced, CACalifornia | — | $232.18 |
| Modesto, CACalifornia | — | $232.18 |
| Napa, CACalifornia | — | $250.99 |
| Oxnard, CACalifornia | — | $241.55 |
| Redding, CACalifornia | — | $232.18 |
| Rest of CaliforniaCalifornia | — | $232.18 |
| Riverside, CACalifornia | — | $242.39 |
| Sacramento, CACalifornia | — | $238.89 |
| Salinas, CACalifornia | — | $237.91 |
| San Diego, CACalifornia | — | $240.09 |
| Marin County, CACalifornia | — | $259.52 |
| San Francisco, CACalifornia | — | $258.45 |
| San Benito County, CACalifornia | — | $266.06 |
| Santa Clara County, CACalifornia | — | $261.65 |
| San Luis Obispo, CACalifornia | — | $234.66 |
| Santa Cruz, CACalifornia | — | $239.65 |
| Santa Maria, CACalifornia | — | $237.87 |
| Santa Rosa, CACalifornia | — | $241.75 |
| Stockton, CACalifornia | — | $232.18 |
| Vallejo, CACalifornia | — | $249.43 |
| Visalia, CACalifornia | — | $232.18 |
| Yuba City, CACalifornia | — | $232.18 |
| ColoradoColorado | — | $237.36 |
| ConnecticutConnecticut | — | $252.92 |
| DelawareDelaware | — | $235.66 |
| Fort Lauderdale, FLFlorida | — | $265.21 |
| Rest of FloridaFlorida | — | $252.23 |
| Atlanta, GAGeorgia | — | $246.57 |
| Rest of GeorgiaGeorgia | — | $238.67 |
| Hawaii, Guam, HIHawaii | — | $233.37 |
| IowaIowa | — | $214.77 |
| IdahoIdaho | — | $217.47 |
| East St. Louis, ILIllinois | — | $266.37 |
| Rest of IllinoisIllinois | — | $251.65 |
| Suburban Chicago, ILIllinois | — | $265.92 |
| IndianaIndiana | — | $218.29 |
| KansasKansas | — | $217.53 |
| KentuckyKentucky | — | $229.71 |
| New Orleans, LALouisiana | — | $239.72 |
| Rest of LouisianaLouisiana | — | $230.84 |
| Metropolitan Boston, MAMassachusetts | — | $252.66 |
| Rest of MassachusettsMassachusetts | — | $237.83 |
| Baltimore area, MDMaryland | — | $252.94 |
| Rest of MarylandMaryland | — | $238.40 |
| Rest of MaineMaine | — | $222.20 |
| Southern Maine, MEMaine | — | $226.59 |
| Detroit, MIMichigan | — | $258.56 |
| Rest of MichiganMichigan | — | $237.88 |
| MinnesotaMinnesota | — | $218.15 |
| Metropolitan Kansas City, MOMissouri | — | $234.56 |
| Metropolitan St. Louis, MOMissouri | — | $236.11 |
| Rest of MissouriMissouri | — | $230.02 |
| MississippiMississippi | — | $222.50 |
| MontanaMontana | — | $238.75 |
| North CarolinaNorth Carolina | — | $223.49 |
| North DakotaNorth Dakota | — | $219.97 |
| NebraskaNebraska | — | $214.63 |
| New HampshireNew Hampshire | — | $237.22 |
| Northern New JerseyNew Jersey | — | $259.63 |
| Rest of New JerseyNew Jersey | — | $253.18 |
| New MexicoNew Mexico | — | $240.40 |
| NevadaNevada | — | $233.58 |
| NYC suburbs and Long Island, NYNew York | — | $286.49 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $257.69 |
| Queens, NYNew York | — | $272.91 |
| Rest of New YorkNew York | — | $226.50 |
| OhioOhio | — | $234.04 |
| OklahomaOklahoma | — | $225.56 |
| Portland, OROregon | — | $239.50 |
| Rest of OregonOregon | — | $229.16 |
| Metropolitan Philadelphia, PAPennsylvania | — | $250.00 |
| Rest of PennsylvaniaPennsylvania | — | $232.33 |
| Puerto RicoPuerto Rico | — | $238.98 |
| Rhode IslandRhode Island | — | $240.13 |
| South CarolinaSouth Carolina | — | $229.67 |
| South DakotaSouth Dakota | — | $217.75 |
| TennesseeTennessee | — | $218.87 |
| Austin, TXTexas | — | $238.85 |
| Beaumont, TXTexas | — | $231.36 |
| Brazoria, TXTexas | — | $232.51 |
| Dallas, TXTexas | — | $235.42 |
| Fort Worth, TXTexas | — | $235.26 |
| Galveston, TXTexas | — | $234.15 |
| Houston, TXTexas | — | $251.54 |
| Rest of TexasTexas | — | $232.79 |
| UtahUtah | — | $232.11 |
| VirginiaVirginia | — | $228.51 |
| Virgin Islands, VIUnited States Virgin Islands | — | $238.98 |
| VermontVermont | — | $222.56 |
| Rest of WashingtonWashington | — | $236.24 |
| King County, WAWashington | — | $253.59 |
| WisconsinWisconsin | — | $214.43 |
| West VirginiaWest Virginia | — | $244.92 |
| WyomingWyoming | — | $230.57 |
32609 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 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
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.
The exact Arkansas inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
3,745
- Code
- 32609
- Physician work
- 4.47
- Practice expense
- 1.73
- Malpractice
- 0.95
GPCI2026.csv
7
- Locality
- Arkansas
- Physician work
- 1.000
- Practice expense
- 0.859
- Malpractice
- 0.515
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.47 | × 1.000 | 4.4700 |
| Practice expense | 1.73 | × 0.859 | 1.4861 |
| Malpractice | 0.95 | × 0.515 | 0.4892 |
| Total RVUs | 6.4453 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Arkansas$215.28
Facility: (4.47 × 1 + 1.73 × 0.859 + 0.95 × 0.515) × $33.4009 = $215.28
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
| 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
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%).
How 32609 has changed in Arkansas
32609 · 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 | $215.28 | RVU26D |
| 2026-07-01 | Not available in this setting | $215.28 | RVU26C |
| 2026-04-01 | Not available in this setting | $215.28 | RVU26B |
| 2026-01-01 | Not available in this setting | $215.28 | RVU26A |
| 2025-10-01 | Not available in this setting | $220.26 | RVU25D |
| 2025-07-01 | Not available in this setting | $220.26 | RVU25C |
| 2025-04-01 | Not available in this setting | $220.26 | RVU25B |
| 2025-01-01 | Not available in this setting | $220.26 | RVU25A |
| 2024-10-01 | Not available in this setting | $226.21 | RVU24D |
| 2024-07-01 | Not available in this setting | $226.21 | RVU24C |
| 2024-04-01 | Not available in this setting | $226.21 | RVU24B |
| 2024-03-09 | Not available in this setting | $226.21 | RVU24AR |
| 2024-01-01 | Not available in this setting | $222.52 | RVU24A |
| 2023-10-01 | Not available in this setting | $228.03 | RVU23D |
| 2023-07-01 | Not available in this setting | $228.03 | RVU23C |
| 2023-04-01 | Not available in this setting | $228.03 | RVU23B |
| 2023-01-01 | Not available in this setting | $228.03 | RVU23A |
| 2022-10-01 | Not available in this setting | $231.40 | RVU22D |
| 2022-07-01 | Not available in this setting | $231.40 | RVU22C |
| 2022-04-01 | Not available in this setting | $231.40 | RVU22B |
| 2022-01-01 | Not available in this setting | $231.40 | RVU22A |
| 2021-10-01 | Not available in this setting | $233.15 | RVU21D |
| 2021-07-01 | Not available in this setting | $233.15 | RVU21C |
| 2021-04-01 | Not available in this setting | $233.15 | RVU21B |
| 2021-01-01 | Not available in this setting | $233.15 | RVU21A |
| 2020-10-01 | Not available in this setting | $242.05 | RVU20D |
| 2020-07-01 | Not available in this setting | $242.05 | RVU20C |
| 2020-04-01 | Not available in this setting | $242.05 | RVU20B |
| 2020-01-01 | Not available in this setting | $242.05 | RVU20A |
| 2019-10-01 | Not available in this setting | $244.90 | RVU19D |
| 2019-07-01 | Not available in this setting | $244.90 | RVU19C |
| 2019-04-01 | Not available in this setting | $244.90 | RVU19B |
| 2019-01-01 | Not available in this setting | $244.90 | RVU19A |
| 2018-10-01 | Not available in this setting | $245.26 | RVU18D |
| 2018-07-01 | Not available in this setting | $245.26 | RVU18C |
| 2018-04-01 | Not available in this setting | $245.26 | RVU18B |
| 2018-01-01 | Not available in this setting | $245.26 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $244.35 | RVU17D |
| 2017-07-01 | Not available in this setting | $244.35 | RVU17C |
| 2017-04-01 | Not available in this setting | $244.35 | RVU17B |
| 2017-01-01 | Not available in this setting | $244.35 | RVU17A |
| 2016-10-01 | Not available in this setting | $243.64 | RVU16D |
| 2016-07-01 | Not available in this setting | $243.64 | RVU16C |
| 2016-04-01 | Not available in this setting | $243.64 | RVU16B |
| 2016-01-01 | Not available in this setting | $243.64 | RVU16A |
| 2015-10-01 | Not available in this setting | $244.83 | RVU15D |
| 2015-07-01 | Not available in this setting | $244.83 | RVU15C |
| 2015-04-01 | Not available in this setting | $243.61 | RVU15B |
| 2015-01-01 | Not available in this setting | $243.61 | RVU15A |
| 2014-10-01 | Not available in this setting | $243.24 | RVU14D |
| 2014-07-01 | Not available in this setting | $243.24 | RVU14C |
| 2014-04-01 | Not available in this setting | $243.24 | RVU14B |
| 2014-01-01 | Not available in this setting | $243.24 | RVU14A |
| 2013-10-01 | Not available in this setting | $244.33 | RVU13D |
| 2013-07-01 | Not available in this setting | $244.33 | RVU13C |
| 2013-04-01 | Not available in this setting | $244.33 | RVU13B |
| 2013-01-01 | Not available in this setting | $244.33 | RVU13AR |
Where the Arkansas rate applies
Arkansas is a Medicare payment area, not a city. Our Census mapping connects it to 626 cities and communities in Arkansas. Some span more than one payment area; confirm with the service ZIP.
- Acorn
- Adona
- Alexander
- Alicia
- Alix
- Alleene
- Allport
- Alma
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
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