Billing code 32036: Empyema surgeryMedicare rate & RVUs in Guam
Reports operative drainage for chronic empyema when the surgeon uses a muscle or omental flap to fill the pleural space.
CMS doesn’t publish an office rate for 32036 in Guam.
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 32036 covers
A thoracic surgeon uses this operation to manage chronic empyema, a persistent infected collection in the pleural space. The surgeon opens the chest wall to drain the cavity and brings in a vascularized flap, such as muscle or omentum, to occupy the space. The service is generally performed in a hospital operating room; the flap work distinguishes it from drainage through a chest tube or an operation involving rib resection without a flap.
Select the code when the operative report supports chronic empyema treatment with flap placement, not merely pleural drainage. Document the affected side, the chronic pleural infection, and the flap tissue and operative work. Medicare classifies this as major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. For bilateral surgery, modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; 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.
32036 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $769.53 |
How the 32036 rate is calculated
Each of 32036’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 · 32036
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.99Practice expense 8.18Malpractice 3.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 32036
32036 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 32036
Empyema surgery
| 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) | 0.10/0.76/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 32036
Empyema surgery
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
32036 without 50 · national facility
$774.57
Empyema surgery
32036-50 · Bilateral: 150%
$1,161.86
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).
32036 compared with similar codes
Compare codes
32036 vs 32035 vs 32551 vs 32555: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 32035Thoracostomy
- Choose 32036 when the chronic empyema operation includes a flap to fill the pleural space. Choose 32035 when the described operation uses rib resection.
- 32551Chest tube
- Code 32551 is for tube thoracostomy drainage. It does not describe the open chronic empyema operation with flap placement.
- 32555Thoracentesis
- Code 32555 describes image-guided thoracentesis for pleural fluid drainage, not surgical drainage with flap placement for chronic empyema.
32036 billing questions
How is this different from code 32035?
This code describes chronic empyema surgery using a flap to fill the pleural space. Code 32035 describes empyema surgery with rib resection instead.
Does routine chest-tube drainage support this code?
No. The operative service must include flap placement for chronic empyema; tube drainage alone is a different service.
What documentation supports reporting this code?
The operative report should identify chronic empyema, the side treated, and the flap tissue used and describe the flap work.
How should bilateral procedures be reported?
For bilateral surgery, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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