No office rate
Use 32601 for diagnostic thoracoscopy without the mediastinal mass biopsy described here. When the surgeon biopsies the mediastinal target, select the biopsy service.
On this page
CMS RVU26D · Effective 2026-10-01
32606 Thoracoscopy biopsy Medicare reimbursement rates in Hawaii
Report this service when a surgeon uses thoracoscopy to obtain biopsy tissue from a mediastinal mass or lesion for diagnostic evaluation. Compare 32606 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 32606 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
$411.60
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 32606: Thoracoscopic mediastinal mass biopsy
Report this service when a surgeon uses thoracoscopy to obtain biopsy tissue from a mediastinal mass or lesion for diagnostic evaluation.
A thoracic surgeon uses a scope and instruments introduced through chest-wall ports to inspect the chest and obtain tissue from a mediastinal mass or lesion. The specimen may help evaluate an abnormality seen on imaging or clarify a suspected mediastinal disease. The service is generally performed in an operating room with the patient under anesthesia; it is not the code for sampling a lung nodule, pulmonary infiltrate, pleura, or pericardial sac.
Select the code according to the sampled target and thoracoscopic approach, and document the mediastinal site, the biopsy performed, and the operative findings. Biopsies of multiple portions of a mediastinal mass during the same session are reported as the procedure, not as separate units for each specimen. 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 the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 32606
- 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 RVU8.18 · 64%
- Practice expense (office) RVU2.60 · 20%
- Malpractice RVU2.05 · 16%
208
Medicare services in 2024 · #4290 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.
32606 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
32607 is for thoracoscopic biopsy of a pulmonary infiltrate. This code is selected when the tissue comes from a mediastinal mass or lesion.
No office rate
32608 describes biopsy of a lung nodule. Choose this code for a mediastinal mass biopsy, not a nodule within lung parenchyma.
No office rate
32662 describes thoracoscopic excision of a mediastinal lesion. This code applies when the surgeon obtains biopsy tissue rather than performing the excision service.
Compare 32606 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
$411.60
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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 32606 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,742
- Code
- 32606
- Physician work
- 8.18
- Practice expense
- 2.60
- Malpractice
- 2.05
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.18 | × 1.000 | 8.1800 |
| Practice expense | 2.60 | × 1.137 | 2.9562 |
| Malpractice | 2.05 | × 0.579 | 1.1869 |
| Total RVUs | 12.3231 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$411.60
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.18 | 1 |
| Practice expense | 2.6 | 1.137 |
| Malpractice | 2.05 | 0.579 |
(8.18 × 1 + 2.6 × 1.137 + 2.05 × 0.579) × $33.4009 = $411.60
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.
32606 billing questions
How is this different from a thoracoscopic lung biopsy code?
Use this code when the sampled target is a mediastinal mass or lesion. Codes 32607 and 32608 describe biopsy of a pulmonary infiltrate and lung nodule, respectively.
Can multiple mediastinal biopsy specimens be billed as multiple units?
The service covers biopsy of the mediastinal target, including multiple biopsy samples obtained during the same session. Do not count each specimen as a separate unit.
Is a separate diagnostic thoracoscopy also reported?
When the thoracoscopy includes biopsy of the mediastinal mass, report the biopsy service rather than separately reporting diagnostic thoracoscopy for the same operative inspection.
Can modifier 50 be used when both sides are sampled?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 is not appropriate.
What documentation supports this code?
The operative report should identify the mediastinal target, confirm that the surgeon obtained biopsy tissue, and describe the thoracoscopic approach.
When is an assistant-at-surgery payable?
CMS payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons and team surgery are 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.
3,73932562,,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
3,74532609,,Thoracoscopy w/bx pleura,A,,4.47,1.73,NA,1.73,,0.95,7.15,7.15,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,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