No office rate
Choose 32604 when pericardial sac tissue is sampled. Choose 32601 for diagnostic thoracoscopic inspection without that biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
32604 Thoracoscopic biopsy Medicare reimbursement rates in Hawaii
Report this service when a surgeon uses thoracoscopy to obtain tissue from the pericardial sac for diagnostic evaluation during a chest procedure. Compare 32604 office and facility rates across CMS payment localities in Hawaii.
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 32604 in Hawaii?
Hawaii 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
$427.80
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 32604: Thoracoscopic pericardial sac biopsy
Report this service when a surgeon uses thoracoscopy to obtain tissue from the pericardial sac for diagnostic evaluation during a chest procedure.
A thoracic surgeon uses a thoracoscope through small chest incisions to inspect the operative field and take tissue from the pericardial sac. The biopsy may help evaluate suspected pericardial disease, including abnormal tissue or a process associated with a pericardial effusion. The service is generally performed in an operating room, commonly in a hospital setting, with the patient under anesthesia.
Select this code when the operative report documents thoracoscopic tissue sampling specifically from the pericardial sac; biopsies of pleura, lung, or mediastinum are described by different codes. The record should identify the sampled site and the biopsy performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 32604
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.55 · 64%
- Practice expense (office) RVU2.65 · 20%
- Malpractice RVU2.15 · 16%
39
Medicare services in 2024 · #5517 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.
32604 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
32606 applies to biopsy of mediastinal tissue; 32604 requires biopsy of the pericardial sac.
No office rate
32609 is for pleural biopsy. Identify whether the sampled tissue is pleura or pericardial sac before selecting the code.
No office rate
32661 describes thoracoscopic excision of pericardial tissue, a more extensive removal than the tissue sampling reported with 32604.
Compare 32604 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
$427.80
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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 32604 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,741
- Code
- 32604
- Physician work
- 8.55
- Practice expense
- 2.65
- Malpractice
- 2.15
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.55 | × 1.000 | 8.5500 |
| Practice expense | 2.65 | × 1.137 | 3.0130 |
| Malpractice | 2.15 | × 0.579 | 1.2448 |
| Total RVUs | 12.8079 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$427.80
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.55 | 1 |
| Practice expense | 2.65 | 1.137 |
| Malpractice | 2.15 | 0.579 |
(8.55 × 1 + 2.65 × 1.137 + 2.15 × 0.579) × $33.4009 = $427.80
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.
32604 billing questions
How does this differ from diagnostic thoracoscopy?
Use this code when the surgeon obtains tissue from the pericardial sac. Diagnostic thoracoscopy describes inspection without this pericardial sac biopsy.
Which biopsy site determines the code?
The tissue site determines the choice. Pericardial sac tissue supports this code; pleural, mediastinal, and lung tissue point to their respective thoracoscopic biopsy codes.
Can modifier 50 be used for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. The operative record should support each distinct service performed.
What documentation supports assistant-at-surgery payment?
The record must document the medical necessity of the assistant for payment. CMS does not permit co-surgeons or team surgery for this code.
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.
3,73832561,,Lyse chest fibrin init day,A,,1.36,1.52,,0.29,,0.15,3.03,1.80,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,73932562,,Lyse chest fibrin subq day,A,,1.21,1.41,,0.27,,0.13,2.75,1.61,0,000,0.00,0.00,0.00,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,74032601,,Thoracoscopy diagnostic,A,,5.36,1.96,NA,1.96,,1.31,8.63,8.63,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,74132604,,Thoracoscopy wbx sac,A,,8.55,2.65,NA,2.65,,2.15,13.35,13.35,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,74232606,,Thoracoscopy w/bx med space,A,,8.18,2.60,NA,2.60,,2.05,12.83,12.83,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,74332607,,Thoracoscopy w/bx infiltrate,A,,5.36,1.97,NA,1.97,,1.33,8.66,8.66,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,74432608,,Thoracoscopy w/bx nodule,A,,6.67,2.23,NA,2.23,,1.67,10.57,10.57,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,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