Billing code 32664: Thoracoscopic sympathectomyMedicare rate & RVUs in Florida
Reports video-assisted thoracoscopic excision of thoracic sympathetic nerve tissue, commonly performed to treat severe primary palmar hyperhidrosis.
CMS doesn’t publish an office rate for 32664 in Florida.
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 9 sections
What 32664 covers
A thoracic surgeon uses a thoracoscopic approach to excise part of the thoracic sympathetic chain or its nerve tissue. A common indication is severe primary palmar hyperhidrosis when surgical treatment is chosen. The operation is generally performed in a hospital operating room under general anesthesia; the operative report should identify the treated side and the extent of nerve excision.
Report this code for the thoracoscopic sympathetic nerve excision, rather than for removal of a lung lobe, mediastinal mass, or thymus. Documentation should support the indication, approach, laterality, and actual excision performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with 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 32664 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $913.82 |
| Miami | Unavailable | $1,004.68 |
| Rest Of Florida | Unavailable | $864.80 |
How the 32664 rate is calculated
Each of 32664’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 · 32664
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 13.92Practice expense 7.02Malpractice 3.50
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 32664
32664 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 32664
Thoracoscopic sympathectomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 32664
Thoracoscopic sympathectomy
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
32664 without 50 · national facility
$816.32
Thoracoscopic sympathectomy
32664-50 · Bilateral: 150%
$1,224.48
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).
32664 compared with similar codes
Compare codes
32664 vs 32662 vs 32673 vs 32663: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 32662Mediastinal excision
- Choose 32664 for excision of thoracic sympathetic nerve tissue; choose 32662 when the thoracoscopic target is a mediastinal lesion.
- 32673Thoracoscopic thymectomy
- Code 32673 represents thoracoscopic thymus removal. It is not the code for sympathetic-chain excision.
- 32663Thoracoscopic lobectomy
- Code 32663 is for thoracoscopic removal of a lung lobe; 32664 targets thoracic sympathetic nerve tissue.
32664 billing questions
When should this code be selected instead of 32662?
Use 32664 for thoracoscopic excision of thoracic sympathetic nerve tissue. Code 32662 describes excision of a mediastinal lesion, not a sympathetic-chain operation.
How does this differ from 32673?
Code 32673 is for thoracoscopic thymus removal. Use 32664 when the operative target is thoracic sympathetic nerve tissue.
What documentation supports reporting 32664?
The operative report should describe the thoracoscopic approach, the sympathetic nerve tissue excised, the treated side, and the clinical indication, such as severe primary palmar hyperhidrosis.
How is bilateral surgery reported?
For bilateral performance, report modifier 50; CMS pays the bilateral procedure at 150%.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, CMS pays the highest-valued procedure in full and the other procedure or procedures at 50%.
What are the assistant and co-surgeon payment rules?
An assistant at surgery may be paid. Co-surgeons are paid only with 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
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