CPT code 32658: Thoracoscopy, pericardial foreign body removal2026 Medicare rate & RVUs in Missouri
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 doesn’t publish an office rate for 32658 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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On this page 9 sections
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 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 | $679.90 |
| Metropolitan St. Louis, MO | Unavailable | $685.13 |
| Rest of Missouri | Unavailable | $662.82 |
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
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
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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) | 0.09/0.84/0.07 | Share 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.
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%).
32658 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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