Billing code 32035: ThoracostomyMedicare rate & RVUs in Texas
Reports surgical opening of the chest with rib resection to provide drainage for empyema, rather than drainage by chest tube alone.
CMS doesn’t publish an office rate for 32035 in Texas.
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 32035 covers
The surgeon removes a portion of a rib while creating an opening into the chest to drain empyema, a collection of infected material in the pleural space. This is a more extensive operation than placing a chest tube and is typically performed by a thoracic surgeon in a facility operating room for a patient who needs surgical drainage.
Report the code when the operative documentation supports both the thoracostomy and rib resection for empyema. A tube placed for pleural drainage alone, or an open-flap drainage approach, represents a different service. Medicare assigns a 90-day global period, which 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 multiple procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery 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 32035 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $733.22 |
| Beaumont | Unavailable | $696.85 |
| Brazoria | Unavailable | $707.72 |
| Dallas | Unavailable | $716.62 |
| Fort Worth | Unavailable | $715.14 |
| Galveston | Unavailable | $712.68 |
| Houston | Unavailable | $763.20 |
| Rest Of Texas | Unavailable | $704.88 |
How the 32035 rate is calculated
Each of 32035’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 · 32035
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.01Practice expense 8.01Malpractice 2.76
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 32035
32035 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 32035
Thoracostomy
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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) | 0.10/0.76/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 32035
Thoracostomy
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 50 · payment effect
With and without the modifier
32035 without 50 · national facility
$727.47
Thoracostomy
32035-50 · Bilateral: 150%
$1,091.21
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
32035 compared with similar codes
Compare codes
32035 vs 32036 vs 32551: national Medicare rates
Swap in your local Medicare rate.
How to choose
32035 billing questions
What documentation supports reporting this code?
The operative report should describe empyema drainage through a thoracostomy that includes rib resection. Documentation of chest tube placement alone does not support this service.
How does this differ from an open-flap thoracostomy?
This code represents thoracostomy with rib resection for empyema. Code 32036 describes an open-flap drainage approach, such as an Eloesser flap.
Can this code be used for routine chest tube placement?
No. A chest tube placed without the rib-resection operation is a different service; consider the applicable tube thoracostomy code instead.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are assistants and co-surgeons handled?
An assistant at surgery 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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