CPT code 32656: Thoracoscopic pleurectomy, parietal pleura removal2026 Medicare rate & RVUs in Missouri
Thoracoscopic parietal pleurectomy removes pleural lining, typically during operative treatment of recurrent pneumothorax or selected pleural disease.
CMS doesn’t publish an office rate for 32656 in Missouri.
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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What 32656 covers
Code 32656 represents removal of parietal pleura through a thoracoscopic approach, commonly performed by a thoracic surgeon using video-assisted thoracic surgery. A recognized setting is operative treatment of recurrent spontaneous pneumothorax, where pleural resection helps promote adhesion between the lung and chest wall. The target is the parietal pleura lining the chest wall, not a fibrous peel stripped from the lung during decortication.
Report the code when the operative note supports thoracoscopic pleurectomy, including the side and the pleural tissue removed; the diagnosis or a stated intent to create pleural adhesion alone does not establish that pleurectomy was performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; 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 32656 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.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $762.17 |
| Metropolitan St. Louis, MO | Unavailable | $767.98 |
| Rest of Missouri | Unavailable | $743.43 |
How the 32656 rate is calculated
Each of 32656’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 · 32656
RVUs × geographic indexes × conversion factor
Work12.93
12.93 RVUs× 1.000 GPCI
Practice expense7.16
7.16 RVUs× 1.000 GPCI
Malpractice3.24
3.24 RVUs× 1.000 GPCI
Adjusted RVUs
23.3300
Conversion factor
$33.4009
Medicare rate
$779.24
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 32656
32656 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 32656
Thoracoscopic pleurectomy, parietal pleura removal
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 32656
Thoracoscopic pleurectomy, parietal pleura removal
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 50 · payment effect
With and without the modifier
32656 without 50 · national facility
$779.24
Thoracoscopic pleurectomy, parietal pleura removal
32656-50 · Bilateral: 150%
$1,168.86
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
32656 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 32609Pleural biopsyThoracoscopic approach
- Choose 32609 when thoracoscopy is used to obtain a pleural biopsy for diagnosis. Choose 32656 when the surgeon removes parietal pleura as a therapeutic procedure.
- 32650PleurodesisThoracoscopic approach
- 32650 reports thoracoscopic pleurodesis; 32656 reports removal of parietal pleura. The operative report should identify which procedure was performed.
- 32651Thoracoscopic decorticationPartial decortication
- 32651 is for partial pulmonary decortication, removing a peel from the lung. 32656 targets the parietal pleura lining the chest wall.
- 32652Thoracoscopic decorticationTotal pulmonary decortication
- 32652 describes total pulmonary decortication. It is distinct from 32656, which reports thoracoscopic parietal pleurectomy.
32656 billing questions
How is pleurectomy distinguished from thoracoscopic decortication?
32656 is for removal of parietal pleura lining the chest wall. Decortication codes 32651 and 32652 address removal of a fibrous peel from the lung.
What operative documentation supports 32656?
The operative report should identify the thoracoscopic approach and describe resection of parietal pleura, including the side and extent when documented. A diagnosis such as recurrent pneumothorax by itself does not show that pleurectomy was performed.
How is bilateral pleurectomy reported?
CMS lists this as a bilateral procedure; modifier 50 is paid at 150%. The operative record should support work on both sides.
What postoperative care is included in the global period?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Assistant-at-surgery payment may be available, while co-surgeon payment requires supporting documentation.
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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