No office rate
Choose 32609 when thoracoscopy is used to obtain a pleural biopsy for diagnosis. Choose 32656 when the surgeon removes parietal pleura as a therapeutic procedure.
On this page
CMS RVU26D · Effective 2026-10-01
32656 Thoracoscopic pleurectomy Medicare reimbursement rates in Missouri
Thoracoscopic parietal pleurectomy removes pleural lining, typically during operative treatment of recurrent pneumothorax or selected pleural disease. Compare 32656 office and facility rates across CMS payment localities in Missouri.
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 32656 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$743.43–$767.98
3 of 3 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.
Where 32656 pays more and less in Missouri
Thoracic surgery
About 32656: Thoracoscopic parietal pleurectomy
Thoracoscopic parietal pleurectomy removes pleural lining, typically during operative treatment of recurrent pneumothorax or selected pleural disease.
Code 32656 represents removal of parietal pleura through a thoracoscopic approach, commonly performed by a thoracic surgeon using video-assisted thoracic surgery. A recognized setting is operative treatment of recurrent spontaneous pneumothorax, where pleural resection helps promote adhesion between the lung and chest wall. The target is the parietal pleura lining the chest wall, not a fibrous peel stripped from the lung during decortication.
Report the code when the operative note supports thoracoscopic pleurectomy, including the side and the pleural tissue removed; the diagnosis or a stated intent to create pleural adhesion alone does not establish that pleurectomy was performed. CMS assigns a 90-day global period, including 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 others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 32656
- 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 RVU12.93 · 55%
- Practice expense (office) RVU7.16 · 31%
- Malpractice RVU3.24 · 14%
780
Medicare services in 2024 · #3178 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.
32656 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
32650 reports thoracoscopic pleurodesis; 32656 reports removal of parietal pleura. The operative report should identify which procedure was performed.
No office rate
32651 is for partial pulmonary decortication, removing a peel from the lung. 32656 targets the parietal pleura lining the chest wall.
No office rate
32652 describes total pulmonary decortication. It is distinct from 32656, which reports thoracoscopic parietal pleurectomy.
Compare 32656 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$762.17
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$767.98
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$743.43
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32656 billing questions
How is pleurectomy distinguished from thoracoscopic decortication?
32656 is for removal of parietal pleura lining the chest wall. Decortication codes 32651 and 32652 address removal of a fibrous peel from the lung.
What operative documentation supports 32656?
The operative report should identify the thoracoscopic approach and describe resection of parietal pleura, including the side and extent when documented. A diagnosis such as recurrent pneumothorax by itself does not show that pleurectomy was performed.
How is bilateral pleurectomy reported?
CMS lists this as a bilateral procedure; modifier 50 is paid at 150%. The operative record should support work on both sides.
What postoperative care is included in the global period?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Assistant-at-surgery payment may be available, while co-surgeon payment requires supporting documentation.
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.
3,75032653,,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
3,7563265F,,Rna tstng hepc vir ord/docd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00