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CPT code 32658: Thoracoscopy, pericardial foreign body removal2026 Medicare rate & RVUs

Reports thoracoscopic surgery to remove a foreign body from the pericardial sac, typically performed by a thoracic or cardiothoracic surgeon in an operating room.

CMS RVU26DEffective Oct 1, 2026109 payment localities45 Medicare services in 2024

Medicare pays $695.41 for 32658 nationally in a facility.

Medicare rate · 32658

Thoracoscopy, pericardial foreign body removal

Office or facility?

Work RVUs
11.42
Total RVUs
20.82
Global days
090

National rate · 2026

$695.41

Facility setting, before claim adjustments.

See every locality for 32658 →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 32658 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 32658 covers

A thoracic or cardiothoracic surgeon uses a thoracoscopic approach to locate and remove a foreign body from the pericardial sac. The service is performed in an operating room, generally in a hospital facility, when the operative target is material within that sac rather than the pleural space or the pericardium itself. The operative report should identify the foreign body, its location, and the thoracoscopic removal performed.

Report this code for removal from the pericardial sac, not for drainage of the sac or excision of pericardial tissue. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this single pericardial structure. 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 32658 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

32658 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$626.54
AlaskaUnavailable$857.26
ArizonaUnavailable$674.84
ArkansasUnavailable$618.16
Atlanta, GAUnavailable$719.31
Austin, TXUnavailable$697.89
Bakersfield, CAUnavailable$686.11
Baltimore area, MDUnavailable$740.15
Beaumont, TXUnavailable$668.97
Brazoria, TXUnavailable$675.41

32658 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
32658 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 32658 rate is calculated

Each of 32658’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 · 32658

RVUs × geographic indexes × conversion factor

Office or facility?

Work11.42

11.42 RVUs× 1.000 GPCI

Practice expense6.53

6.53 RVUs× 1.000 GPCI

Malpractice2.87

2.87 RVUs× 1.000 GPCI

Adjusted RVUs

20.8200

Conversion factor

$33.4009

Medicare rate

$695.41

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

Payment rules and modifiers for 32658

32658 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 32658

Thoracoscopy, pericardial foreign body removal

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are 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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 32658

Thoracoscopy, pericardial foreign body 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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

32658 without 51 · national facility

$695.41

Thoracoscopy, pericardial foreign body removal

32658-51 · Second procedure: 50%

$347.71

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

32658 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 32658

    Thoracoscopy, pericardial foreign body removal11.42 wRVU

    Not priced

  • 32659

    Pericardial drainage, thoracoscopic approach11.64 wRVU

    Not priced

  • 32661

    Pericardial excision, thoracoscopic cyst or mass13 wRVU

    Not priced

  • 32653

    Thoracoscopy removal, foreign body or fibrin17.72 wRVU

    Not priced

How to choose

32659Pericardial drainageThoracoscopic approach
32658 is for removing a foreign body from the pericardial sac; 32659 is for thoracoscopic drainage of that sac.
32661Pericardial excisionThoracoscopic cyst or mass
32658 removes a foreign body from the sac. Use 32661 for thoracoscopic excision of pericardial tissue.
32653Thoracoscopy removalForeign body or fibrin
Both involve thoracoscopic removal, but 32653 addresses foreign body or fibrin in the pleural space, not the pericardial sac.

Codes related to 32658

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

Codes related to 32658
CodeHow it relatesNational office range
Same family
32659Pericardial drainage, thoracoscopic approachThoracoscopic pericardial sac procedure for drainage rather than foreign body removal.No office rate
32661Pericardial excision, thoracoscopic cyst or massThoracoscopic pericardial surgery involving excision rather than foreign body removal.No office rate
32653Thoracoscopy removal, foreign body or fibrinThoracoscopic foreign body or fibrin removal code directed to the pleural space.No office rate

32658 billing questions

How is this code distinguished from 32659?

Use 32658 when the surgeon removes a foreign body from the pericardial sac. Code 32659 describes thoracoscopic drainage of the sac.

Can drainage of the pericardial sac be reported with this code?

Choose the code that represents the operative service performed. Do not report drainage as a separate service solely because fluid or other material is encountered during foreign body removal.

Should modifier 50 be appended?

No. The pericardial sac is a single structure, so modifier 50 is inappropriate for this service.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What documentation supports reporting this code?

Document the foreign body and its location in the pericardial sac, the thoracoscopic approach, and the removal performed. The operative note should distinguish this work from pericardial drainage or tissue excision.

How does the multiple-procedure rule affect payment?

For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction.

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 32658PPRRVU2026_Oct_nonQPP.csv, line 3,754 (RVU26D)

Open CMS sourceHow we calculate rates

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