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Billing code 32665: Esophageal myotomyMedicare rate & RVUs

Reports thoracoscopic division or removal of esophageal muscle, typically for achalasia, with fundoplasty included when performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities19 Medicare services in 2024

Medicare pays $1,167.36 for 32665 nationally in a facility.

Medicare rate · 32665

Esophageal myotomy

Work RVUs
20.99
Total RVUs
34.95
Global days
090

National rate · 2026

$1,167.36

Facility setting, before claim adjustments.

See every locality for 32665 →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 32665 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 32665 covers

This code describes a thoracoscopic Heller-type myotomy: the surgeon reaches the esophagus through the chest and divides or excises muscle to relieve an obstructive esophageal motility disorder, most commonly achalasia. The operation is performed by a thoracic or other appropriately trained surgeon in an operating room. Fundoplasty performed as part of the operation is included in this service rather than separately reported as a separate procedure.

Report the code when the operative record supports a thoracoscopic esophageal muscle procedure, not merely inspection, biopsy, or resection of another thoracic structure. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery services may be paid; 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 32665 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

32665 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,054.69
Alaska*Unavailable$1,457.74
ArizonaUnavailable$1,133.02
ArkansasUnavailable$1,041.06
AtlantaUnavailable$1,209.49
AustinUnavailable$1,165.53
BakersfieldUnavailable$1,139.72
Baltimore/Surr. CntysUnavailable$1,241.48
BeaumontUnavailable$1,128.74
BrazoriaUnavailable$1,131.63

32665 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
32665 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 32665 rate is calculated

Each of 32665’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 · 32665

RVUs × geographic indexes × conversion factor

Work20.99

20.99 RVUs× 1.000 GPCI

Practice expense8.69

8.69 RVUs× 1.000 GPCI

Malpractice5.27

5.27 RVUs× 1.000 GPCI

Adjusted RVUs

34.9500

Conversion factor

$33.4009

Medicare rate

$1,167.36

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

Payment rules and modifiers for 32665

32665 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 32665

Esophageal myotomy

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)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 32665

Esophageal myotomy

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

32665 without 51 · national facility

$1,167.36

Esophageal myotomy

32665-51 · Second procedure: 50%

$583.68

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

32665 compared with similar codes

Compare codes · National

4 codes, side by side

  • 32665

    Esophageal myotomy20.99 wRVU

    Not priced

  • 43279

    Heller myotomy21.55 wRVU

    Not priced

  • 43330

    Esophageal myotomy21.64 wRVU

    Not priced

  • 43331

    Esophageal myotomy22.48 wRVU

    Not priced

How to choose

43279Heller myotomy
Use 43279 for a laparoscopic Heller myotomy through the abdomen; use 32665 when the surgeon performs the myotomy thoracoscopically through the chest.
43330Esophageal myotomy
This code describes a thoracoscopic operation. billing code 43330 describes an open Heller-type myotomy through an abdominal approach.
43331Esophageal myotomy
billing code 43331 describes an open thoracic Heller-type myotomy; 32665 is the thoracoscopic approach.

Codes related to 32665

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

Codes related to 32665
CodeHow it relatesNational office range
Used instead
43279Heller myotomyLaparoscopic Heller myotomy for the same esophageal muscle procedure using an abdominal approach.No office rate
43330Esophageal myotomyOpen Heller-type esophagomyotomy using an abdominal approach.No office rate
43331Esophageal myotomyOpen Heller-type esophagomyotomy using a thoracic approach.No office rate

32665 billing questions

How does this differ from laparoscopic Heller myotomy?

This code is for the thoracoscopic route through the chest. billing code 43279 describes the laparoscopic route through the abdomen.

Can fundoplasty be reported separately?

Fundoplasty performed as part of the thoracoscopic Heller procedure is included in this code and is not separately reported as that component.

What documentation supports reporting this code?

The operative report should identify the thoracoscopic approach and describe the esophageal muscle myotomy or excision, along with any fundoplasty performed.

Does modifier 50 apply when both sides are treated?

No. Modifier 50 is inappropriate for this code because the descriptor and anatomy do not support bilateral adjustment.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and related postoperative care for 90 days are included in the global period.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; 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 32665PPRRVU2026_Oct_nonQPP.csv, line 3,761 (RVU26D)

Open CMS sourceHow we calculate rates

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