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Billing code 32220: Lung decorticationMedicare rate & RVUs

Removal of a restrictive fibrous layer from the lung to permit re-expansion, typically for trapped lung associated with empyema or other pleural disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.3K Medicare services in 2024

Medicare pays $1,538.45 for 32220 nationally in a facility.

Medicare rate · 32220

Lung decortication

Swap in your local Medicare rate.

Work RVUs
25.98
Total RVUs
46.06
Global days
090

National rate · 2026

$1,538.45

Facility setting, before claim adjustments.

See every locality for 32220 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 32220 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 32220 covers

Pulmonary decortication removes a dense fibrous peel constricting the lung so the lung can expand. Thoracic surgeons typically perform the operation in a hospital operating room, often through an open chest approach, for a trapped lung associated with empyema or other pleural disease. The work is directed at freeing the lung, rather than draining a lung abscess or removing only parietal pleura.

Report 32220 when the operative record supports complete pulmonary decortication; use the partial-decortication code when only part of the lung is released. Documentation should identify the restrictive peel, the extent of its removal, and the resulting release of the lung. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment 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 32220 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

32220 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,387.83
Alaska*Unavailable$1,904.84
ArizonaUnavailable$1,493.23
ArkansasUnavailable$1,369.54
AtlantaUnavailable$1,591.76
AustinUnavailable$1,541.91
BakersfieldUnavailable$1,514.08
Baltimore/Surr. CntysUnavailable$1,636.73
BeaumontUnavailable$1,482.19
BrazoriaUnavailable$1,493.75

32220 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
32220 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 32220 rate is calculated

Each of 32220’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 · 32220

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 25.98Practice expense 13.61Malpractice 6.47

46.0600 adjusted RVUs×$33.4009 conversion factor=$1,538.45

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 32220

32220 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 32220

Lung decortication

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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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)0.10/0.76/0.14Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 32220

Lung decortication

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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 50 · payment effect

With and without the modifier

32220 without 50 · national facility

$1,538.45

Lung decortication

32220-50 · Bilateral: 150%

$2,307.68

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).

When to use modifier 50

32220 compared with similar codes

Compare codes

32220 vs 32225 vs 32652 vs 32215 vs 32200: national Medicare rates

Swap in your local Medicare rate.

  • 32220
    Lung decortication · 25.98 wRVU
    —
  • 32225
    Lung decortication · 16.33 wRVU
    —
  • 32652
    Thoracoscopic decortication · 28.4 wRVU
    —
  • 32215
    Pleurectomy · 12.72 wRVU
    —
  • 32200
    Lung abscess drainage · 18.21 wRVU
    —

How to choose

32225Lung decortication
Use 32220 for complete pulmonary release and 32225 when decortication is partial. The operative description of extent determines the choice.
32652Thoracoscopic decortication
32652 describes total decortication performed thoracoscopically. Compare the documented surgical approach before selecting it instead of 32220.
32215Pleurectomy
32215 concerns removal of parietal pleura; 32220 frees the lung by removing its constricting fibrous peel. The operative target distinguishes them.
32200Lung abscess drainage
32200 addresses open drainage of a lung abscess or cyst. It does not describe releasing a lung constrained by a fibrous peel.

Codes related to 32220

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

Codes related to 32220
CodeHow it relatesNational office range
Same family
32225Lung decorticationPulmonary decortication when the operative release is partial rather than complete.No office rate
Used instead
32651Thoracoscopic decorticationThoracoscopic option for partial pulmonary decortication.No office rate
32652Thoracoscopic decorticationThoracoscopic option for total pulmonary decortication.No office rate

32220 billing questions

How is 32220 different from 32225?

32220 is for complete pulmonary decortication. Use 32225 when the operative work releases only part of the lung.

What documentation supports complete decortication?

The operative report should describe the restrictive fibrous peel, its removal from the lung, and the extent of the release. The documented work should support complete rather than partial decortication.

Can 32220 be reported with thoracoscopic decortication codes?

For thoracoscopic total decortication, compare 32220 with 32652; for thoracoscopic partial decortication, compare it with 32651. Select the code matching the documented approach and extent rather than reporting both for the same work.

Does the 90-day global period include postoperative visits?

Yes. The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care.

How does CMS handle bilateral reporting and multiple procedures?

Bilateral reporting with modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%.

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 32220PPRRVU2026_Oct_nonQPP.csv, line 3,705 (RVU26D)

Open CMS sourceHow we calculate rates

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