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Billing code 32504: Apical tumor resectionMedicare rate & RVUs

Reports resection of an apical lung tumor involving the chest wall when the surgeon also reconstructs the chest wall during the operation.

CMS RVU26DEffective Oct 1, 2026109 payment localities40 Medicare services in 2024

Medicare pays $1,919.55 for 32504 nationally in a facility.

Medicare rate · 32504

Apical tumor resection

Work RVUs
35.63
Total RVUs
57.47
Global days
090

National rate · 2026

$1,919.55

Facility setting, before claim adjustments.

See every locality for 32504 →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 32504 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 32504 covers

A thoracic surgeon removes an apical lung tumor, such as a Pancoast tumor, along with involved chest wall, then reconstructs the chest wall during the same operation. The service is performed in an operating room and may involve en bloc removal of tumor and chest-wall structures followed by reconstruction. The reconstruction distinguishes this service from apical tumor resection without reconstruction.

Report this code when the operative documentation supports both apical tumor resection involving the chest wall and chest-wall reconstruction. The reconstruction is part of the coded service. Medicare assigns a 90-day global period, which 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 others are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this code. 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 32504 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

32504 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,735.58
Alaska*Unavailable$2,407.66
ArizonaUnavailable$1,863.01
ArkansasUnavailable$1,713.40
AtlantaUnavailable$1,990.34
AustinUnavailable$1,912.59
BakersfieldUnavailable$1,865.96
Baltimore/Surr. CntysUnavailable$2,041.09
BeaumontUnavailable$1,859.60
BrazoriaUnavailable$1,859.15

32504 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
32504 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 32504 rate is calculated

Each of 32504’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 · 32504

RVUs × geographic indexes × conversion factor

Work35.63

35.63 RVUs× 1.000 GPCI

Practice expense12.85

12.85 RVUs× 1.000 GPCI

Malpractice8.99

8.99 RVUs× 1.000 GPCI

Adjusted RVUs

57.4700

Conversion factor

$33.4009

Medicare rate

$1,919.55

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

Payment rules and modifiers for 32504

32504 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 32504

Apical tumor resection

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)0.10/0.76/0.14Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 32504

Apical tumor resection

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

32504 without 51 · national facility

$1,919.55

Apical tumor resection

32504-51 · Second procedure: 50%

$959.78

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

32504 compared with similar codes

Compare codes · National

4 codes, side by side

  • 32504

    Apical tumor resection35.63 wRVU

    Not priced

  • 32503

    Lung tumor resection30.95 wRVU

    Not priced

  • 32505

    Lung wedge resection15.36 wRVU

    Not priced

  • 32507

    Lung wedge resection2.93 wRVU

    Not priced

How to choose

32503Lung tumor resection
Choose 32504 when chest-wall reconstruction accompanies apical tumor resection. Choose 32503 when the apical tumor resection includes chest wall but no reconstruction.
32505Lung wedge resection
32505 describes an initial lung wedge resection. It does not represent apical tumor resection involving the chest wall with reconstruction.
32507Lung wedge resection
32507 is for a diagnostic lung wedge resection. Use 32504 for therapeutic resection of an apical tumor involving the chest wall with reconstruction.

Codes related to 32504

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

Codes related to 32504
CodeHow it relatesNational office range
Same family
32503Lung tumor resectionApical lung tumor resection including chest wall, but without chest-wall reconstruction.No office rate
Used instead
32505Lung wedge resectionInitial wedge resection for a lung lesion when the apical tumor and chest-wall reconstruction service is not performed.No office rate
32507Lung wedge resectionDiagnostic lung wedge resection when tissue sampling, rather than apical tumor resection with reconstruction, is performed.No office rate

32504 billing questions

How does this differ from 32503?

Both codes describe apical lung tumor resection that includes chest wall. Use 32504 when chest-wall reconstruction is performed; 32503 describes the procedure without reconstruction.

Is chest-wall reconstruction separately reported?

Reconstruction is included in 32504 when performed as part of the apical tumor resection. The operative report should document the reconstruction.

Can modifier 50 be used for bilateral surgery?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

Can an assistant or co-surgeon be reported?

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

What postoperative care is included?

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

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 32504PPRRVU2026_Oct_nonQPP.csv, line 3,723 (RVU26D)

Open CMS sourceHow we calculate rates

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