No office rate
Use 43279 for a laparoscopic Heller myotomy through the abdomen; use 32665 when the surgeon performs the myotomy thoracoscopically through the chest.
On this page
CMS RVU26D · Effective 2026-10-01
32665 Esophageal myotomy Medicare reimbursement rates in Arkansas
Reports thoracoscopic division or removal of esophageal muscle, typically for achalasia, with fundoplasty included when performed. Compare 32665 office and facility rates across CMS payment localities in Arkansas.
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.
What does Medicare pay for 32665 in Arkansas?
Arkansas has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1041.06
1 of 1 localities have a supported rate.
Payment area: Arkansas
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Thoracic surgery
About 32665: Thoracoscopic esophageal myotomy
Reports thoracoscopic division or removal of esophageal muscle, typically for achalasia, with fundoplasty included when performed.
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.
CMS billing rules for 32665
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU20.99 · 60%
- Practice expense (office) RVU8.69 · 25%
- Malpractice RVU5.27 · 15%
19
Medicare services in 2024 · #5944 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.
32665 compared with similar codes
Office rates for Arkansas, from the same CMS release.
No office rate
This code describes a thoracoscopic operation. CPT 43330 describes an open Heller-type myotomy through an abdominal approach.
No office rate
CPT 43331 describes an open thoracic Heller-type myotomy; 32665 is the thoracoscopic approach.
Compare 32665 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Arkansas →
Office / nonfacility
Unavailable
Facility
$1041.06
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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 32665 in Arkansas.
PPRRVU2026_Oct_nonQPP.csv
3,761
- Code
- 32665
- Physician work
- 20.99
- Practice expense
- 8.69
- Malpractice
- 5.27
GPCI2026.csv
7
- Locality
- Arkansas
- Physician work
- 1.000
- Practice expense
- 0.859
- Malpractice
- 0.515
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 20.99 | × 1.000 | 20.9900 |
| Practice expense | 8.69 | × 0.859 | 7.4647 |
| Malpractice | 5.27 | × 0.515 | 2.7140 |
| Total RVUs | 31.1688 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Arkansas$1041.06
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 20.99 | 1 |
| Practice expense | 8.69 | 0.859 |
| Malpractice | 5.27 | 0.515 |
(20.99 × 1 + 8.69 × 0.859 + 5.27 × 0.515) × $33.4009 = $1041.06
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.
32665 billing questions
How does this differ from laparoscopic Heller myotomy?
This code is for the thoracoscopic route through the chest. CPT 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 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.
3,75832662,,Thoracoscopy w/mediast exc,A,,14.62,7.49,NA,7.49,,3.66,25.77,25.77,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75932663,,Thoracoscopy w/lobectomy,A,,24.02,9.43,NA,9.43,,6.03,39.48,39.48,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,76032664,,Thoracoscopy w/ th nrv exc,A,,13.92,7.02,NA,7.02,,3.50,24.44,24.44,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,76132665,,Thoracoscop w/esoph musc exc,A,,20.99,8.69,NA,8.69,,5.27,34.95,34.95,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,76232666,,Thoracoscopy w/wedge resect,A,,14.14,7.42,NA,7.42,,3.56,25.12,25.12,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,76332667,,Thoracoscopy w/w resect addl,A,,2.93,0.58,NA,0.58,,0.73,4.24,4.24,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,76432668,,Thoracoscopy w/w resect diag,A,,2.93,0.59,NA,0.59,,0.73,4.25,4.25,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609
901112,CA,55,CHICO,1.017,1.096,0.536
1001182,CA,71,EL CENTRO,1.017,1.096,0.541