No office rate
32655 is for resection of pulmonary bullae. Use 32666 when the surgeon performs a thoracoscopic wedge resection for another lung target.
On this page
CMS RVU26D · Effective 2026-10-01
32655 Bulla resection Medicare reimbursement rates in Guam
Reports thoracoscopic removal of pulmonary bullae, commonly during surgery for spontaneous pneumothorax or symptomatic bullous lung disease. Compare 32655 office and facility rates across CMS payment localities in Guam.
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 32655 in Guam?
Guam 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
$895.54
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 32655: Thoracoscopic bulla resection
Reports thoracoscopic removal of pulmonary bullae, commonly during surgery for spontaneous pneumothorax or symptomatic bullous lung disease.
A thoracic surgeon uses a thoracoscopic approach to remove one or more abnormal air-filled spaces in the lung, often to treat a persistent or recurrent spontaneous pneumothorax or symptomatic bullous disease. The service is generally performed in an operating room, with the resected bulla removed through the thoracic access sites. The code includes pleural procedures performed as part of the bulla resection.
The operative report should identify the bulla resected, its location, the thoracoscopic approach, and the clinical reason for surgery. This major procedure has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others 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.
CMS billing rules for 32655
- 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 RVU15.77 · 58%
- Practice expense (office) RVU7.70 · 28%
- Malpractice RVU3.95 · 14%
790
Medicare services in 2024 · #3158 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.
32655 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
32650 describes thoracoscopic pleurodesis. Pleural work performed as part of 32655 is included in the bulla-resection service.
No office rate
32656 is thoracoscopic pleurectomy. It is distinguished by removal of pleural tissue as the operative service rather than resection of a pulmonary bulla.
No office rate
32651 describes thoracoscopic decortication, which removes a restrictive layer from the lung or pleura; 32655 removes pulmonary bullae.
Compare 32655 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$895.54
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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 32655 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,752
- Code
- 32655
- Physician work
- 15.77
- Practice expense
- 7.70
- Malpractice
- 3.95
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.77 | × 1.000 | 15.7700 |
| Practice expense | 7.70 | × 1.137 | 8.7549 |
| Malpractice | 3.95 | × 0.579 | 2.2870 |
| Total RVUs | 26.8120 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$895.54
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.77 | 1 |
| Practice expense | 7.7 | 1.137 |
| Malpractice | 3.95 | 0.579 |
(15.77 × 1 + 7.7 × 1.137 + 3.95 × 0.579) × $33.4009 = $895.54
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.
32655 billing questions
How is 32655 different from thoracoscopic wedge resection?
Use 32655 when the target is a pulmonary bulla. Code 32666 describes thoracoscopic wedge resection for a different lung target, such as a lesion requiring wedge removal.
Can pleurodesis be reported separately with 32655?
Pleural procedures performed as part of the bulla resection are included in 32655. Do not separately report 32650 for pleurodesis that is part of that service.
What documentation supports 32655?
Document the thoracoscopic approach, the bulla removed and its lung location, and the indication, such as persistent pneumothorax or symptomatic bullous disease.
How does Medicare handle bilateral bulla resection?
The CMS rule pays bilateral reporting with modifier 50 at 150%. The operative record should support treatment on both sides.
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-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 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.
3,74932652,,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
3,75532659,,Thoracoscopy w/sac drainage,A,,11.64,6.90,NA,6.90,,2.91,21.45,21.45,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014