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CPT code 32659: Pericardial drainage, thoracoscopic approach2026 Medicare rate & RVUs

Report this service when a surgeon uses thoracoscopy to drain fluid from the pericardial sac, commonly for a pericardial effusion.

CMS RVU26DEffective Oct 1, 2026109 payment localities565 Medicare services in 2024

Medicare pays $716.45 for 32659 nationally in a facility.

Medicare rate · 32659

Pericardial drainage, thoracoscopic approach

Office or facility?

Work RVUs
11.64
Total RVUs
21.45
Global days
090

National rate · 2026

$716.45

Facility setting, before claim adjustments.

See every locality for 32659 →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 32659 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 32659 covers

A thoracic surgeon uses a thoracoscope to reach and drain fluid from the sac surrounding the heart. In an operating room, this may involve creating a pericardial window so fluid can drain into the chest. The service is used for pericardial effusions requiring surgical drainage; it is distinct from needle drainage through the skin.

Report 32659 when the operative work is thoracoscopic drainage of the pericardial sac. The operative note should establish the thoracoscopic approach, the pericardial fluid or collection treated, and the drainage performed; distinguish this from removal of a foreign body or excision of pericardium. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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 32659 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

32659 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$645.46
AlaskaUnavailable$882.18
ArizonaUnavailable$695.31
ArkansasUnavailable$636.81
Atlanta, GAUnavailable$740.84
Austin, TXUnavailable$719.51
Bakersfield, CAUnavailable$707.96
Baltimore area, MDUnavailable$762.53
Beaumont, TXUnavailable$688.81
Brazoria, TXUnavailable$696.10

32659 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
32659 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 32659 rate is calculated

Each of 32659’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 · 32659

RVUs × geographic indexes × conversion factor

Office or facility?

Work11.64

11.64 RVUs× 1.000 GPCI

Practice expense6.90

6.90 RVUs× 1.000 GPCI

Malpractice2.91

2.91 RVUs× 1.000 GPCI

Adjusted RVUs

21.4500

Conversion factor

$33.4009

Medicare rate

$716.45

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

Payment rules and modifiers for 32659

32659 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 32659

Pericardial drainage, thoracoscopic approach

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 · 32659

Pericardial drainage, thoracoscopic approach

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

32659 without 51 · national facility

$716.45

Pericardial drainage, thoracoscopic approach

32659-51 · Second procedure: 50%

$358.23

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

32659 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 32659

    Pericardial drainage, thoracoscopic approach11.64 wRVU

    Not priced

  • 32658

    Thoracoscopy, pericardial foreign body removal11.42 wRVU

    Not priced

  • 33016

    Pericardiocentesis, imaging included4.29 wRVU

    Not priced

  • 33025

    Pericardial window, open surgical drainage12.87 wRVU

    Not priced

How to choose

32658ThoracoscopyPericardial foreign body removal
Use 32659 for thoracoscopic drainage of the pericardial sac. Use 32658 when the thoracoscopic work removes a foreign body from the sac.
33016PericardiocentesisImaging included
33016 is percutaneous pericardiocentesis with imaging guidance. Choose 32659 when the surgeon performs drainage through a thoracoscopic approach.
33025Pericardial windowOpen surgical drainage
33025 describes creation of a pericardial window or partial resection for drainage. 32659 identifies thoracoscopic drainage.

Codes related to 32659

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

Codes related to 32659
CodeHow it relatesNational office range
Same family
32658Thoracoscopy, pericardial foreign body removalThoracoscopic treatment of the pericardial sac by foreign-body removal rather than drainage.No office rate
Used instead
33016Pericardiocentesis, imaging includedPercutaneous pericardiocentesis with imaging guidance rather than thoracoscopic surgical drainage.No office rate
33025Pericardial window, open surgical drainagePericardial window or partial resection for drainage by an approach other than this thoracoscopic service.No office rate

32659 billing questions

How is 32659 different from pericardiocentesis?

32659 is for surgical drainage performed through a thoracoscopic approach. Pericardiocentesis uses percutaneous needle or catheter access rather than thoracoscopic surgery.

How is 32659 different from 32658?

32659 covers drainage of the pericardial sac. 32658 is for thoracoscopic removal of a foreign body from that sac.

Does 32659 include creation of a pericardial window?

A thoracoscopic window may be part of the drainage procedure. The operative note should describe the approach and the work performed.

What documentation supports reporting 32659?

Document the thoracoscopic approach, the pericardial collection treated, and the drainage performed. The note should make clear that the service was drainage rather than foreign-body removal or pericardiectomy.

What global period applies to 32659?

CMS assigns a 90-day global period. It includes the day-before preoperative visit and 90 days of related postoperative care.

Can modifier 50 be reported for 32659?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this pericardial-sac service.

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 32659PPRRVU2026_Oct_nonQPP.csv, line 3,755 (RVU26D)

Open CMS sourceHow we calculate rates

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