FeeBase
Log inGet started
Menu

Billing code 32604: Thoracoscopic biopsyMedicare rate & RVUs

Report this service when a surgeon uses thoracoscopy to obtain tissue from the pericardial sac for diagnostic evaluation during a chest procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities39 Medicare services in 2024

Medicare pays $445.90 for 32604 nationally in a facility.

Medicare rate · 32604

Thoracoscopic biopsy

Swap in your local Medicare rate.

Work RVUs
8.55
Total RVUs
13.35
Global days
000

National rate · 2026

$445.90

Facility setting, before claim adjustments.

See every locality for 32604 → · 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 32604 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 32604 covers

A thoracic surgeon uses a thoracoscope through small chest incisions to inspect the operative field and take tissue from the pericardial sac. The biopsy may help evaluate suspected pericardial disease, including abnormal tissue or a process associated with a pericardial effusion. The service is generally performed in an operating room, commonly in a hospital setting, with the patient under anesthesia.

Select this code when the operative report documents thoracoscopic tissue sampling specifically from the pericardial sac; biopsies of pleura, lung, or mediastinum are described by different codes. The record should identify the sampled site and the biopsy performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are 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 32604 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

32604 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$403.67
Alaska*Unavailable$562.20
ArizonaUnavailable$432.82
ArkansasUnavailable$398.59
AtlantaUnavailable$462.61
AustinUnavailable$443.42
BakersfieldUnavailable$431.75
Baltimore/Surr. CntysUnavailable$473.95
BeaumontUnavailable$432.84
BrazoriaUnavailable$431.59

32604 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
32604 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 32604 rate is calculated

Each of 32604’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 · 32604

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 8.55Practice expense 2.65Malpractice 2.15

13.3500 adjusted RVUs×$33.4009 conversion factor=$445.90

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

Payment rules and modifiers for 32604

The CMS indicators that decide how 32604 is paid alongside other services.

CMS payment indicators · 32604

Thoracoscopic biopsy

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

32604 without 51 · national facility

$445.90

Thoracoscopic biopsy

32604-51 · Second procedure: 50%

$222.95

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

32604 compared with similar codes

Compare codes

32604 vs 32601 vs 32606 vs 32609 vs 32661: national Medicare rates

Swap in your local Medicare rate.

  • 32604
    Thoracoscopic biopsy · 8.55 wRVU
    —
  • 32601
    Diagnostic thoracoscopy · 5.36 wRVU
    —
  • 32606
    Thoracoscopy biopsy · 8.18 wRVU
    —
  • 32609
    Pleural biopsy · 4.47 wRVU
    —
  • 32661
    Pericardial excision · 13 wRVU
    —

How to choose

32601Diagnostic thoracoscopy
Choose 32604 when pericardial sac tissue is sampled. Choose 32601 for diagnostic thoracoscopic inspection without that biopsy.
32606Thoracoscopy biopsy
32606 applies to biopsy of mediastinal tissue; 32604 requires biopsy of the pericardial sac.
32609Pleural biopsy
32609 is for pleural biopsy. Identify whether the sampled tissue is pleura or pericardial sac before selecting the code.
32661Pericardial excision
32661 describes thoracoscopic excision of pericardial tissue, a more extensive removal than the tissue sampling reported with 32604.

Codes related to 32604

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

Codes related to 32604
CodeHow it relatesNational office range
Used instead
32601Diagnostic thoracoscopyDiagnostic thoracoscopy is used when inspection is performed without the pericardial sac biopsy.No office rate
Same family
32606Thoracoscopy biopsyThoracoscopic biopsy of mediastinal tissue rather than the pericardial sac.No office rate
32609Pleural biopsyThoracoscopic biopsy of pleural tissue rather than the pericardial sac.No office rate
32608Thoracoscopic biopsyThoracoscopic biopsy directed to a lung nodule rather than the pericardial sac.No office rate

32604 billing questions

How does this differ from diagnostic thoracoscopy?

Use this code when the surgeon obtains tissue from the pericardial sac. Diagnostic thoracoscopy describes inspection without this pericardial sac biopsy.

Which biopsy site determines the code?

The tissue site determines the choice. Pericardial sac tissue supports this code; pleural, mediastinal, and lung tissue point to their respective thoracoscopic biopsy codes.

Can modifier 50 be used for bilateral work?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

What happens when another procedure is performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. The operative record should support each distinct service performed.

What documentation supports assistant-at-surgery payment?

The record must document the medical necessity of the assistant for payment. CMS does not permit co-surgeons or team surgery for this code.

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 32604PPRRVU2026_Oct_nonQPP.csv, line 3,741 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 32604 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 32604 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →