Billing code 32604: Thoracoscopic biopsyMedicare rate & RVUs in Illinois
Report this service when a surgeon uses thoracoscopy to obtain tissue from the pericardial sac for diagnostic evaluation during a chest procedure.
CMS doesn’t publish an office rate for 32604 in Illinois.
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 32604 covers
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.
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 32604 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $541.34 |
| East St. Louis | Unavailable | $511.64 |
| Rest Of Illinois | Unavailable | $478.63 |
| Suburban Chicago | Unavailable | $505.73 |
How the 32604 rate is calculated
Each of 32604’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 · 32604
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.55Practice expense 2.65Malpractice 2.15
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 32604
The CMS indicators that decide how 32604 is paid alongside other services.
CMS payment indicators · 32604
Thoracoscopic biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
32604 without 51 · national facility
$445.90
Thoracoscopic biopsy
32604-51 · Second procedure: 50%
$222.95
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
32604 compared with similar codes
Compare codes
32604 vs 32601 vs 32606 vs 32609 vs 32661: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 32601Diagnostic thoracoscopy
- Choose 32604 when pericardial sac tissue is sampled. Choose 32601 for diagnostic thoracoscopic inspection without that biopsy.
- 32606Thoracoscopy biopsy
- 32606 applies to biopsy of mediastinal tissue; 32604 requires biopsy of the pericardial sac.
- 32609Pleural biopsy
- 32609 is for pleural biopsy. Identify whether the sampled tissue is pleura or pericardial sac before selecting the code.
- 32661Pericardial excision
- 32661 describes thoracoscopic excision of pericardial tissue, a more extensive removal than the tissue sampling reported with 32604.
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 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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