Billing code 32609: Pleural biopsyMedicare rate & RVUs in Nebraska
Report this service when a surgeon uses thoracoscopy to obtain pleural tissue, such as for evaluation of unexplained effusion or abnormal pleura.
CMS doesn’t publish an office rate for 32609 in Nebraska.
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 32609 covers
A thoracic surgeon uses a scope passed through the chest wall to inspect the pleural space and collect tissue from the pleura. This is commonly performed in a hospital operating room when imaging or prior evaluation shows pleural thickening, nodules, or an unexplained effusion and tissue is needed to investigate possible malignancy, infection, or another pleural disorder. The specimen is sent for pathologic examination.
Report the code when pleural tissue is sampled; the scope inspection needed to locate and obtain that sample is part of the service, rather than a separate diagnostic thoracoscopy. The operative report should identify the pleural target and document that tissue was collected. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. 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.
32609 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | Unavailable | $214.63 |
How the 32609 rate is calculated
Each of 32609’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 · 32609
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.47Practice expense 1.73Malpractice 0.95
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 32609
The CMS indicators that decide how 32609 is paid alongside other services.
CMS payment indicators · 32609
Pleural 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
32609 without 51 · national facility
$238.82
Pleural biopsy
32609-51 · Second procedure: 50%
$119.41
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%).
32609 compared with similar codes
Compare codes
32609 vs 32601 vs 32606 vs 32607 vs 32608: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 32601Diagnostic thoracoscopy
- Choose 32609 when pleural tissue is sampled. Choose 32601 for diagnostic thoracoscopy when no pleural biopsy is performed.
- 32606Thoracoscopy biopsy
- 32609 covers sampling pleura; 32606 is for thoracoscopic biopsy of the mediastinal space.
- 32607Lung biopsy
- 32609 is selected for a pleural specimen. 32607 applies when the sampled target is a pulmonary infiltrate.
- 32608Thoracoscopic biopsy
- Use 32609 for pleural tissue and 32608 when thoracoscopic biopsy targets a pulmonary nodule.
32609 billing questions
When should this be chosen over diagnostic thoracoscopy?
Use this code when pleural tissue is obtained. A diagnostic thoracoscopy without pleural biopsy is represented by 32601.
Can diagnostic thoracoscopy also be reported?
Do not separately report 32601 for the visualization used to locate and obtain the pleural biopsy; that inspection is part of this service.
Can pleurodesis be performed and reported in the same session?
Pleurodesis may be performed during the same thoracoscopy as pleural biopsy. When both procedures are reported, CMS applies the multiple-procedure reduction to the lower-valued procedure or procedures.
Should modifier 50 be appended for bilateral pleural sampling?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
What documentation supports reporting the biopsy?
The operative report should establish that the sampled tissue was pleura, describe the target or abnormality, and document that a specimen was obtained.
When is assistant-at-surgery payment available?
CMS allows assistant-at-surgery payment only when the record documents 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 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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