No office rate
32658 is for removing a foreign body from the pericardial sac; 32659 is for thoracoscopic drainage of that sac.
On this page
CMS RVU26D · Effective 2026-10-01
32658 Thoracoscopy Medicare reimbursement rates in Missouri
Reports thoracoscopic surgery to remove a foreign body from the pericardial sac, typically performed by a thoracic or cardiothoracic surgeon in an operating room. Compare 32658 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 32658 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
$662.82–$685.13
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 32658 pays more and less in Missouri
Thoracic surgery
About 32658: Thoracoscopic pericardial foreign body removal
Reports thoracoscopic surgery to remove a foreign body from the pericardial sac, typically performed by a thoracic or cardiothoracic surgeon in an operating room.
A thoracic or cardiothoracic surgeon uses a thoracoscopic approach to locate and remove a foreign body from the pericardial sac. The service is performed in an operating room, generally in a hospital facility, when the operative target is material within that sac rather than the pleural space or the pericardium itself. The operative report should identify the foreign body, its location, and the thoracoscopic removal performed.
Report this code for removal from the pericardial sac, not for drainage of the sac or excision of pericardial tissue. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this single pericardial structure. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 32658
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU11.42 · 55%
- Practice expense (office) RVU6.53 · 31%
- Malpractice RVU2.87 · 14%
45
Medicare services in 2024 · #5416 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.
32658 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
32658 removes a foreign body from the sac. Use 32661 for thoracoscopic excision of pericardial tissue.
No office rate
Both involve thoracoscopic removal, but 32653 addresses foreign body or fibrin in the pleural space, not the pericardial sac.
Compare 32658 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
$679.90
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$685.13
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$662.82
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
32658 billing questions
How is this code distinguished from 32659?
Use 32658 when the surgeon removes a foreign body from the pericardial sac. Code 32659 describes thoracoscopic drainage of the sac.
Can drainage of the pericardial sac be reported with this code?
Choose the code that represents the operative service performed. Do not report drainage as a separate service solely because fluid or other material is encountered during foreign body removal.
Should modifier 50 be appended?
No. The pericardial sac is a single structure, so modifier 50 is inappropriate for this service.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports reporting this code?
Document the foreign body and its location in the pericardial sac, the thoracoscopic approach, and the removal performed. The operative note should distinguish this work from pericardial drainage or tissue excision.
How does the multiple-procedure rule affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction.
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.
3,75132654,,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
3,75732661,,Thoracoscopy w/pericard exc,A,,13.00,6.84,NA,6.84,,3.26,23.10,23.10,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00