No office rate
32654 is for operative control of active bleeding; 32653 is for removing clot or a foreign body from the pleural cavity.
On this page
CMS RVU26D · Effective 2026-10-01
32654 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1111.42
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Thoracic surgery
About 32654: Thoracoscopic control of intrathoracic bleeding
Reports operative thoracoscopy to identify and control active intrathoracic bleeding, such as hemorrhage into the pleural space requiring surgical hemostasis.
A thoracic surgeon uses a thoracoscope and operative instruments to locate and stop active bleeding within the chest. The service may be performed in the operating room for significant pleural or intrathoracic hemorrhage when direct operative control is needed. The operative report should identify the bleeding source when found and describe the hemostatic work performed, rather than documenting only inspection or drainage.
Report this code for the operative bleeding-control service, not simply because bleeding is noted during another procedure. The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 results in payment at 150% for a bilateral procedure. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 32654
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU20.01 · 59%
- Practice expense (office) RVU8.93 · 26%
- Malpractice RVU4.83 · 14%
186
Medicare services in 2024 · #4380 by national volume
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.
32654 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
Both address hemorrhage operatively, but 32110 describes an open thoracotomy with repair of a lung tear; 32654 is the thoracoscopic approach.
No office rate
32650 is thoracoscopic pleurodesis, not hemostasis. Select it when the operative service is pleurodesis rather than control of active bleeding.
The same code, a different location
How does Delaware compare?
32654 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Alabama
Alabama · 32654
Office
Unavailable
Facility
$1020.65
No comparable office rate is available.
Arkansas
Arkansas · 32654
Office
Unavailable
Facility
$1007.65
No comparable office rate is available.
Arizona
Arizona · 32654
Office
Unavailable
Facility
$1095.47
No comparable office rate is available.
Bakersfield
California · 32654
Office
Unavailable
Facility
$1106.20
No comparable office rate is available.
Chico
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
El Centro
California · 32654
Office
Unavailable
Facility
$1093.90
No comparable office rate is available.
Fresno
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Hanford-Corcoran
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Madera
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Merced
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Modesto
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Napa
California · 32654
Office
Unavailable
Facility
$1185.53
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 32654
Office
Unavailable
Facility
$1140.13
No comparable office rate is available.
Redding
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Rest Of California
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 32654
Office
Unavailable
Facility
$1144.90
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 32654
Office
Unavailable
Facility
$1125.77
No comparable office rate is available.
Salinas
California · 32654
Office
Unavailable
Facility
$1121.24
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 32654
Office
Unavailable
Facility
$1132.57
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 32654
Office
Unavailable
Facility
$1226.45
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 32654
Office
Unavailable
Facility
$1220.97
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 32654
Office
Unavailable
Facility
$1258.45
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 32654
Office
Unavailable
Facility
$1236.02
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 32654
Office
Unavailable
Facility
$1105.91
No comparable office rate is available.
Santa Cruz-Watsonville
California · 32654
Office
Unavailable
Facility
$1131.26
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 32654
Office
Unavailable
Facility
$1121.32
No comparable office rate is available.
Santa Rosa-Petaluma
California · 32654
Office
Unavailable
Facility
$1141.15
No comparable office rate is available.
Stockton
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Vallejo
California · 32654
Office
Unavailable
Facility
$1177.63
No comparable office rate is available.
Visalia
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Yuba City
California · 32654
Office
Unavailable
Facility
$1093.09
No comparable office rate is available.
Colorado
Colorado · 32654
Office
Unavailable
Facility
$1119.73
No comparable office rate is available.
Connecticut
Connecticut · 32654
Office
Unavailable
Facility
$1198.16
No comparable office rate is available.
Fort Lauderdale
Florida · 32654
Office
Unavailable
Facility
$1262.18
No comparable office rate is available.
Rest Of Florida
Florida · 32654
Office
Unavailable
Facility
$1195.97
No comparable office rate is available.
Atlanta
Georgia · 32654
Office
Unavailable
Facility
$1167.15
No comparable office rate is available.
Rest Of Georgia
Georgia · 32654
Office
Unavailable
Facility
$1126.71
No comparable office rate is available.
Hawaii, Guam
Hawaii · 32654
Office
Unavailable
Facility
$1100.89
No comparable office rate is available.
Iowa
Iowa · 32654
Office
Unavailable
Facility
$1005.32
No comparable office rate is available.
Idaho
Idaho · 32654
Office
Unavailable
Facility
$1019.07
No comparable office rate is available.
East St. Louis
Illinois · 32654
Office
Unavailable
Facility
$1267.67
No comparable office rate is available.
Rest Of Illinois
Illinois · 32654
Office
Unavailable
Facility
$1192.83
No comparable office rate is available.
Suburban Chicago
Illinois · 32654
Office
Unavailable
Facility
$1265.22
No comparable office rate is available.
Indiana
Indiana · 32654
Office
Unavailable
Facility
$1023.25
No comparable office rate is available.
Kansas
Kansas · 32654
Office
Unavailable
Facility
$1019.30
No comparable office rate is available.
Kentucky
Kentucky · 32654
Office
Unavailable
Facility
$1081.13
No comparable office rate is available.
New Orleans
Louisiana · 32654
Office
Unavailable
Facility
$1132.29
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 32654
Office
Unavailable
Facility
$1086.87
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 32654
Office
Unavailable
Facility
$1195.47
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 32654
Office
Unavailable
Facility
$1121.70
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 32654
Office
Unavailable
Facility
$1198.65
No comparable office rate is available.
Rest Of Maryland
Maryland · 32654
Office
Unavailable
Facility
$1124.98
No comparable office rate is available.
Rest Of Maine
Maine · 32654
Office
Unavailable
Facility
$1043.11
No comparable office rate is available.
Southern Maine
Maine · 32654
Office
Unavailable
Facility
$1065.73
No comparable office rate is available.
Detroit
Michigan · 32654
Office
Unavailable
Facility
$1228.18
No comparable office rate is available.
Rest Of Michigan
Michigan · 32654
Office
Unavailable
Facility
$1122.81
No comparable office rate is available.
Minnesota
Minnesota · 32654
Office
Unavailable
Facility
$1023.02
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 32654
Office
Unavailable
Facility
$1106.04
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 32654
Office
Unavailable
Facility
$1113.95
No comparable office rate is available.
Rest Of Missouri
Missouri · 32654
Office
Unavailable
Facility
$1082.59
No comparable office rate is available.
Mississippi
Mississippi · 32654
Office
Unavailable
Facility
$1044.38
No comparable office rate is available.
Montana**
Montana · 32654
Office
Unavailable
Facility
$1127.63
No comparable office rate is available.
North Carolina
North Carolina · 32654
Office
Unavailable
Facility
$1049.73
No comparable office rate is available.
North Dakota**
North Dakota · 32654
Office
Unavailable
Facility
$1032.12
No comparable office rate is available.
Nebraska
Nebraska · 32654
Office
Unavailable
Facility
$1004.64
No comparable office rate is available.
New Hampshire
New Hampshire · 32654
Office
Unavailable
Facility
$1120.01
No comparable office rate is available.
Northern Nj
New Jersey · 32654
Office
Unavailable
Facility
$1228.75
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 32654
Office
Unavailable
Facility
$1197.77
No comparable office rate is available.
New Mexico
New Mexico · 32654
Office
Unavailable
Facility
$1135.62
No comparable office rate is available.
Nevada**
Nevada · 32654
Office
Unavailable
Facility
$1101.31
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 32654
Office
Unavailable
Facility
$1365.35
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 32654
Office
Unavailable
Facility
$1220.24
No comparable office rate is available.
Queens
New York · 32654
Office
Unavailable
Facility
$1296.31
No comparable office rate is available.
Rest Of New York
New York · 32654
Office
Unavailable
Facility
$1065.12
No comparable office rate is available.
Ohio
Ohio · 32654
Office
Unavailable
Facility
$1103.29
No comparable office rate is available.
Oklahoma
Oklahoma · 32654
Office
Unavailable
Facility
$1060.06
No comparable office rate is available.
Portland
Oregon · 32654
Office
Unavailable
Facility
$1130.45
No comparable office rate is available.
Rest Of Oregon
Oregon · 32654
Office
Unavailable
Facility
$1078.84
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 32654
Office
Unavailable
Facility
$1183.34
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 32654
Office
Unavailable
Facility
$1094.62
No comparable office rate is available.
Puerto Rico
Puerto Rico · 32654
Office
Unavailable
Facility
$1128.81
No comparable office rate is available.
Rhode Island
Rhode Island · 32654
Office
Unavailable
Facility
$1133.07
No comparable office rate is available.
South Carolina
South Carolina · 32654
Office
Unavailable
Facility
$1081.08
No comparable office rate is available.
South Dakota**
South Dakota · 32654
Office
Unavailable
Facility
$1020.83
No comparable office rate is available.
Tennessee
Tennessee · 32654
Office
Unavailable
Facility
$1026.11
No comparable office rate is available.
Austin
Texas · 32654
Office
Unavailable
Facility
$1128.19
No comparable office rate is available.
Beaumont
Texas · 32654
Office
Unavailable
Facility
$1089.65
No comparable office rate is available.
Brazoria
Texas · 32654
Office
Unavailable
Facility
$1095.12
No comparable office rate is available.
Dallas
Texas · 32654
Office
Unavailable
Facility
$1109.86
No comparable office rate is available.
Fort Worth
Texas · 32654
Office
Unavailable
Facility
$1108.98
No comparable office rate is available.
Galveston
Texas · 32654
Office
Unavailable
Facility
$1103.46
No comparable office rate is available.
Houston
Texas · 32654
Office
Unavailable
Facility
$1191.87
No comparable office rate is available.
Rest Of Texas
Texas · 32654
Office
Unavailable
Facility
$1097.09
No comparable office rate is available.
Utah
Utah · 32654
Office
Unavailable
Facility
$1093.60
No comparable office rate is available.
Virginia
Virginia · 32654
Office
Unavailable
Facility
$1075.45
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 32654
Office
Unavailable
Facility
$1128.81
No comparable office rate is available.
Vermont
Vermont · 32654
Office
Unavailable
Facility
$1045.27
No comparable office rate is available.
Rest Of Washington
Washington · 32654
Office
Unavailable
Facility
$1113.89
No comparable office rate is available.
Seattle (King Cnty)
Washington · 32654
Office
Unavailable
Facility
$1199.55
No comparable office rate is available.
Wisconsin
Wisconsin · 32654
Office
Unavailable
Facility
$1003.78
No comparable office rate is available.
West Virginia
West Virginia · 32654
Office
Unavailable
Facility
$1158.41
No comparable office rate is available.
Wyoming**
Wyoming · 32654
Office
Unavailable
Facility
$1086.00
No comparable office rate is available.
See how rates vary across the country
32654 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 32654 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1222.56
$1111.42 × 110% = $1222.56
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 32654 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
3,751
- Code
- 32654
- Physician work
- 20.01
- Practice expense
- 8.93
- Malpractice
- 4.83
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 20.01 | × 1.005 | 20.1101 |
| Practice expense | 8.93 | × 0.988 | 8.8228 |
| Malpractice | 4.83 | × 0.899 | 4.3422 |
| Total RVUs | 33.2751 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$1111.42
Open 32654 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 20.01 | 1.005 |
| Practice expense | 8.93 | 0.988 |
| Malpractice | 4.83 | 0.899 |
(20.01 × 1.005 + 8.93 × 0.988 + 4.83 × 0.899) × $33.4009 = $1111.42
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
32654 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1111.42 | RVU26D |
| 2026-07-01 | Not available in this setting | $1111.42 | RVU26C |
| 2026-04-01 | Not available in this setting | $1111.42 | RVU26B |
| 2026-01-01 | Not available in this setting | $1111.42 | RVU26A |
| 2025-10-01 | Not available in this setting | $1147.74 | RVU25D |
| 2025-07-01 | Not available in this setting | $1147.74 | RVU25C |
| 2025-04-01 | Not available in this setting | $1147.74 | RVU25B |
| 2025-01-01 | Not available in this setting | $1147.74 | RVU25A |
32654 billing questions
When is this code appropriate instead of thoracoscopic clot removal?
Use this code when the operative work controls active bleeding. Code 32653 addresses removal of clot or a foreign body from the pleural cavity; document the distinct work if both services are performed.
Does drainage of a bloody pleural collection support this code?
Drainage alone does not establish that bleeding was surgically controlled. The operative note should describe the hemostatic intervention.
How does CMS apply the multiple-procedure rule?
When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How is bilateral reporting handled?
For a bilateral procedure reported with modifier 50, CMS pays at 150%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,74832651,,Thoracoscopy remove cortex,A,,18.31,8.27,NA,8.27,,4.55,31.13,31.13,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,74932652,,Thoracoscopy rem totl cortex,A,,28.40,11.49,NA,11.49,,7.11,47.00,47.00,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75032653,,Thoracoscopy remov fb/fibrin,A,,17.72,8.18,NA,8.18,,4.23,30.13,30.13,0,090,0.10,0.76,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75132654,,Thoracoscopy contrl bleeding,A,,20.01,8.93,NA,8.93,,4.83,33.77,33.77,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75232655,,Thoracoscopy resect bullae,A,,15.77,7.70,NA,7.70,,3.95,27.42,27.42,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75332656,,Thoracoscopy w/pleurectomy,A,,12.93,7.16,NA,7.16,,3.24,23.33,23.33,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75432658,,Thoracoscopy w/sac fb remove,A,,11.42,6.53,NA,6.53,,2.87,20.82,20.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503