Billing code 32665: Esophageal myotomyMedicare rate & RVUs in Oregon
Reports thoracoscopic division or removal of esophageal muscle, typically for achalasia, with fundoplasty included when performed.
CMS doesn’t publish an office rate for 32665 in Oregon.
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 32665 covers
This code describes a thoracoscopic Heller-type myotomy: the surgeon reaches the esophagus through the chest and divides or excises muscle to relieve an obstructive esophageal motility disorder, most commonly achalasia. The operation is performed by a thoracic or other appropriately trained surgeon in an operating room. Fundoplasty performed as part of the operation is included in this service rather than separately reported as a separate procedure.
Report the code when the operative record supports a thoracoscopic esophageal muscle procedure, not merely inspection, biopsy, or resection of another thoracic structure. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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.
Where 32665 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,165.74 |
| Rest Of Oregon | Unavailable | $1,113.92 |
How the 32665 rate is calculated
Each of 32665’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 · 32665
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 20.99Practice expense 8.69Malpractice 5.27
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 32665
32665 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 32665
Esophageal myotomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 32665
Esophageal myotomy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
32665 without 51 · national facility
$1,167.36
Esophageal myotomy
32665-51 · Second procedure: 50%
$583.68
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%).
32665 compared with similar codes
Compare codes
32665 vs 43279 vs 43330 vs 43331: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43279Heller myotomy
- Use 43279 for a laparoscopic Heller myotomy through the abdomen; use 32665 when the surgeon performs the myotomy thoracoscopically through the chest.
- 43330Esophageal myotomy
- This code describes a thoracoscopic operation. billing code 43330 describes an open Heller-type myotomy through an abdominal approach.
- 43331Esophageal myotomy
- billing code 43331 describes an open thoracic Heller-type myotomy; 32665 is the thoracoscopic approach.
32665 billing questions
How does this differ from laparoscopic Heller myotomy?
This code is for the thoracoscopic route through the chest. billing code 43279 describes the laparoscopic route through the abdomen.
Can fundoplasty be reported separately?
Fundoplasty performed as part of the thoracoscopic Heller procedure is included in this code and is not separately reported as that component.
What documentation supports reporting this code?
The operative report should identify the thoracoscopic approach and describe the esophageal muscle myotomy or excision, along with any fundoplasty performed.
Does modifier 50 apply when both sides are treated?
No. Modifier 50 is inappropriate for this code because the descriptor and anatomy do not support bilateral adjustment.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team surgery 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 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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