No office rate
Use 39560 for diaphragm resection followed by simple repair. Use 39561 when the defect needs complex reconstruction, such as graft repair.
On this page
CMS RVU26D · Effective 2026-10-01
39561 Diaphragm resection Medicare reimbursement rates in New Mexico
Report 39561 when diaphragm tissue is removed and the resulting defect requires complex reconstruction, such as closure with a graft. Compare 39561 office and facility rates across CMS payment localities in New Mexico.
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 39561 in New Mexico?
New Mexico has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1217.80
1 of 1 localities have a supported rate.
Payment area: New Mexico
One mapped payment locality.
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 39561: Complex diaphragm resection and reconstruction
Report 39561 when diaphragm tissue is removed and the resulting defect requires complex reconstruction, such as closure with a graft.
Code 39561 describes removal of diaphragm tissue followed by complex repair of the defect, such as reconstruction using a graft. It is most often encountered during a major operation when a tumor or other diseased tissue involves the diaphragm. Thoracic or abdominal surgeons typically perform the work in a hospital operating room. The complex reconstruction distinguishes this service from a resection that can be repaired simply.
Choose this code when the operative report supports both diaphragm resection and complex repair; document the resection and how the defect was reconstructed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code's descriptor and anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 39561
- 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 RVU19.49 · 53%
- Practice expense (office) RVU12.01 · 33%
- Malpractice RVU4.96 · 14%
127
Medicare services in 2024 · #4690 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.
39561 compared with similar codes
Office rates for New Mexico, from the same CMS release.
No office rate
39501 addresses repair of a diaphragm laceration. It does not describe resection followed by complex reconstruction.
No office rate
39540 is for repair of an acute traumatic diaphragmatic hernia. Choose 39561 when diaphragm tissue is resected and the defect receives complex repair.
Compare 39561 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.
1 of 1 payment localities
New Mexico →
Office / nonfacility
Unavailable
Facility
$1217.80
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 39561 in New Mexico.
PPRRVU2026_Oct_nonQPP.csv
4,787
- Code
- 39561
- Physician work
- 19.49
- Practice expense
- 12.01
- Malpractice
- 4.96
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 19.49 | × 1.000 | 19.4900 |
| Practice expense | 12.01 | × 0.917 | 11.0132 |
| Malpractice | 4.96 | × 1.201 | 5.9570 |
| Total RVUs | 36.4601 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, New Mexico$1217.80
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 19.49 | 1 |
| Practice expense | 12.01 | 0.917 |
| Malpractice | 4.96 | 1.201 |
(19.49 × 1 + 12.01 × 0.917 + 4.96 × 1.201) × $33.4009 = $1217.80
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
39561 billing questions
How does 39561 differ from 39560?
Both describe diaphragm resection. Use 39561 when the defect requires complex repair, such as graft reconstruction; 39560 is for a simple repair.
Is the repair or graft separately reported?
The complex repair of the defect created by the diaphragm resection is included in 39561. Document the reconstruction technique in the operative report.
Can modifier 50 be used when both sides are involved?
No. The descriptor and anatomy make modifier 50 inappropriate for this service.
What supports reporting 39561 rather than a diaphragm repair code?
The operative report should establish that diaphragm tissue was resected and that the resulting defect required complex reconstruction. A traumatic tear or hernia repair without this resection is a different service.
What are the global and multiple-procedure payment rules?
The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.
When may an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team-surgery payment is 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 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.
4,78439541,,Repair of diaphragm hernia,A,,15.36,7.25,NA,7.25,,3.98,26.59,26.59,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78539545,,Revision of diaphragm,A,,14.30,8.24,NA,8.24,,3.59,26.13,26.13,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78639560,,Resect diaphragm simple,A,,12.73,6.96,NA,6.96,,3.03,22.72,22.72,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78739561,,Resect diaphragm complex,A,,19.49,12.01,NA,12.01,,4.96,36.46,36.46,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,78839599,,Unlisted px diaphragm,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,7894000F,,Tobacco use txmnt counseling,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
4,7904001F,,Tobacco use txmnt pharmacol,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
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068
7612402,NJ,99,REST OF NEW JERSEY,1.040,1.092,1.097
7704212,NM,05,NEW MEXICO,1.000,0.917,1.201
7813202,NY,01,MANHATTAN,1.064,1.162,1.586
7913202,NY,02,NYC SUBURBS/LONG ISLAND,1.064,1.189,1.857
8013202,NY,03,POUGHKPSIE/N NYC SUBURBS,1.045,1.095,1.210