No office rate
32654 is for operative control of active bleeding; 32653 is for removing clot or a foreign body from the pleural cavity.
On this page
CMS RVU26D · Effective 2026-10-01
32654 Thoracoscopy Medicare reimbursement rates in Massachusetts
Reports operative thoracoscopy to identify and control active intrathoracic bleeding, such as hemorrhage into the pleural space requiring surgical hemostasis. Compare 32654 office and facility rates across CMS payment localities in Massachusetts.
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 32654 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1121.70–$1195.47
2 of 2 localities have a supported rate.
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 32654: Thoracoscopic control of intrathoracic bleeding
Reports operative thoracoscopy to identify and control active intrathoracic bleeding, such as hemorrhage into the pleural space requiring surgical hemostasis.
A thoracic surgeon uses a thoracoscope and operative instruments to locate and stop active bleeding within the chest. The service may be performed in the operating room for significant pleural or intrathoracic hemorrhage when direct operative control is needed. The operative report should identify the bleeding source when found and describe the hemostatic work performed, rather than documenting only inspection or drainage.
Report this code for the operative bleeding-control service, not simply because bleeding is noted during another procedure. The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 results in payment at 150% for a bilateral procedure. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 32654
- 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 RVU20.01 · 59%
- Practice expense (office) RVU8.93 · 26%
- Malpractice RVU4.83 · 14%
186
Medicare services in 2024 · #4380 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.
32654 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
Both address hemorrhage operatively, but 32110 describes an open thoracotomy with repair of a lung tear; 32654 is the thoracoscopic approach.
No office rate
32650 is thoracoscopic pleurodesis, not hemostasis. Select it when the operative service is pleurodesis rather than control of active bleeding.
Compare 32654 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$1195.47
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$1121.70
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32654 billing questions
When is this code appropriate instead of thoracoscopic clot removal?
Use this code when the operative work controls active bleeding. Code 32653 addresses removal of clot or a foreign body from the pleural cavity; document the distinct work if both services are performed.
Does drainage of a bloody pleural collection support this code?
Drainage alone does not establish that bleeding was surgically controlled. The operative note should describe the hemostatic intervention.
How does CMS apply the multiple-procedure rule?
When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.
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-surgeon payment requires supporting documentation; team surgery is not permitted.
How is bilateral reporting handled?
For a bilateral procedure reported with modifier 50, CMS pays at 150%.
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.
3,74832651,,Thoracoscopy remove cortex,A,,18.31,8.27,NA,8.27,,4.55,31.13,31.13,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,74932652,,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