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Billing code 32650: PleurodesisMedicare rate & RVUs

Thoracoscopic pleurodesis creates adhesion between pleural surfaces, commonly to reduce recurrence of pneumothorax or manage recurrent pleural effusion.

CMS RVU26DEffective Oct 1, 2026109 payment localities3.8K Medicare services in 2024

Medicare pays $650.32 for 32650 nationally in a facility.

Medicare rate · 32650

Pleurodesis

Swap in your local Medicare rate.

Work RVUs
10.56
Total RVUs
19.47
Global days
090

National rate · 2026

$650.32

Facility setting, before claim adjustments.

See every locality for 32650 → · 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 32650 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 32650 covers

A thoracic surgeon performs this operation through a thoracoscope to make the visceral and parietal pleura adhere, using a mechanical or chemical technique. Common situations include recurrent pneumothorax and recurrent pleural effusion, including effusion associated with malignancy. The service is typically performed in an operating room or hospital setting under general anesthesia.

Report the code for the thoracoscopic pleurodesis itself, with the operative report identifying the indication, approach, and method used. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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% reduction. For a bilateral procedure reported with modifier 50, CMS pays at 150%. 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 32650 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

32650 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$586.69
Alaska*Unavailable$802.07
ArizonaUnavailable$631.43
ArkansasUnavailable$578.94
AtlantaUnavailable$671.95
AustinUnavailable$653.57
BakersfieldUnavailable$643.95
Baltimore/Surr. CntysUnavailable$691.71
BeaumontUnavailable$625.16
BrazoriaUnavailable$632.42

32650 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
32650 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 32650 rate is calculated

Each of 32650’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 · 32650

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 10.56Practice expense 6.35Malpractice 2.56

19.4700 adjusted RVUs×$33.4009 conversion factor=$650.32

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

Payment rules and modifiers for 32650

32650 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 32650

Pleurodesis

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 · 32650

Pleurodesis

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

32650 without 50 · national facility

$650.32

Pleurodesis

32650-50 · Bilateral: 150%

$975.48

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

32650 compared with similar codes

Compare codes

32650 vs 32560 vs 32609 vs 32656: national Medicare rates

Swap in your local Medicare rate.

  • 32650
    Pleurodesis · 10.56 wRVU
    —
  • 32560
    Chemical pleurodesis · 1.5 wRVU
    $276.23
  • 32609
    Pleural biopsy · 4.47 wRVU
    —
  • 32656
    Thoracoscopic pleurectomy · 12.93 wRVU
    —

How to choose

32560Chemical pleurodesis
Code 32560 describes chemical pleurodesis through a chest tube. Use 32650 when the pleurodesis is performed with a thoracoscopic approach.
32609Pleural biopsy
Code 32609 represents thoracoscopic pleural biopsy. It describes diagnostic tissue sampling, not pleural adhesion treatment.
32656Thoracoscopic pleurectomy
Code 32656 describes thoracoscopic pleurectomy, which removes pleural tissue. Code 32650 is for creating pleural adhesion without coding the service as pleurectomy.

Codes related to 32650

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

Codes related to 32650
CodeHow it relatesNational office range
Used instead
32560Chemical pleurodesisChemical pleurodesis delivered through a chest tube rather than thoracoscopically.$241.70–$374.72
32656Thoracoscopic pleurectomyThoracoscopic pleurectomy is a different surgical approach sometimes selected for recurrent pneumothorax.No office rate
Often billed with
32609Pleural biopsyThoracoscopic pleural biopsy may be performed during the encounter when diagnostic sampling is needed.No office rate

32650 billing questions

When should I report this instead of code 32560?

Report this code when pleurodesis is performed thoracoscopically. Code 32560 describes chemical pleurodesis delivered through a chest tube without a thoracoscopic approach.

How does this differ from thoracoscopic pleurectomy?

Pleurodesis brings the pleural surfaces together to form an adhesion. Pleurectomy removes pleural tissue and is a different operative approach.

Can a pleural biopsy be reported during the same operation?

A pleural biopsy may be performed for diagnostic evaluation during the encounter. Documentation should identify the biopsy site and its separate purpose; apply applicable coding edits when reporting both services.

What does the 90-day global period include?

It includes the day-before preoperative visit and related postoperative care for 90 days after surgery.

How is bilateral pleurodesis handled under the CMS payment facts?

For a bilateral procedure reported with modifier 50, CMS pays at 150%.

May an assistant surgeon be paid for this operation?

CMS permits assistant-at-surgery payment. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.

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 32650PPRRVU2026_Oct_nonQPP.csv, line 3,747 (RVU26D)

Open CMS sourceHow we calculate rates

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