Billing code 32997: Lung lavageMedicare rate & RVUs in Texas
Reports therapeutic washing of an entire lung, typically for pulmonary alveolar proteinosis, using repeated saline instillation and drainage.
CMS doesn’t publish an office rate for 32997 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 32997 covers
Total lung lavage washes an entire lung to remove accumulated material from the air spaces, most commonly in a patient with pulmonary alveolar proteinosis. In a controlled operating-room setting, the lung being treated is isolated while the other lung is ventilated; warmed saline is introduced and drained in repeated cycles. A thoracic surgeon or pulmonologist typically performs the lavage with anesthesia support. The procedure treats a whole lung rather than a focal lesion or an individual airway.
Report the service when the operative record supports therapeutic lavage of the entire lung, including the indication, side treated, lung-isolation approach, and lavage performed. For bilateral treatment, CMS recognizes modifier 50 and pays the bilateral procedure at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this code; 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.
Where 32997 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 | $300.96 |
| Beaumont | Unavailable | $295.06 |
| Brazoria | Unavailable | $297.46 |
| Dallas | Unavailable | $299.45 |
| Fort Worth | Unavailable | $299.28 |
| Galveston | Unavailable | $298.49 |
| Houston | Unavailable | $309.29 |
| Rest Of Texas | Unavailable | $296.20 |
How the 32997 rate is calculated
Each of 32997’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 · 32997
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.13Practice expense 1.27Malpractice 0.59
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 32997
The CMS indicators that decide how 32997 is paid alongside other services.
CMS payment indicators · 32997
Lung lavage
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| 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 50 · payment effect
With and without the modifier
32997 without 50 · national facility
$300.27
Lung lavage
32997-50 · Bilateral: 150%
$450.41
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).
32997 compared with similar codes
Compare codes
32997 vs 32999 vs 32960 vs 32994 vs 32998: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 32999Unlisted px lungs & pleura
- Use 32997 when the service is whole-lung lavage. Consider 32999 only when the lung or pleural procedure performed is not accurately represented by a specific listed code.
- 32960Therapeutic pneumothorax
- 32960 describes therapeutic pneumothorax. It does not represent saline washing and drainage of an entire lung.
- 32994Lung tumor ablation
- 32994 describes percutaneous cryoablation of a pulmonary tumor. It targets a focal tumor rather than washing an entire lung.
- 32998Lung tumor ablation
- 32998 describes percutaneous radiofrequency ablation of a pulmonary tumor. Use 32997 for therapeutic whole-lung lavage, not focal tumor ablation.
32997 billing questions
When is 32997 appropriate instead of a lung tumor ablation code?
Use 32997 for therapeutic washing of an entire lung, typically for pulmonary alveolar proteinosis. Lung tumor ablation codes describe treatment directed at a focal tumor, not diffuse material in the air spaces.
How should bilateral lavage be reported?
When both lungs are treated, report the bilateral service with modifier 50. CMS pays the bilateral procedure at 150%.
What documentation supports 32997?
Document the therapeutic indication, the side or sides treated, lung isolation, and the lavage performed. The record should make clear that the service involved whole-lung washing rather than a focal airway or tumor procedure.
How does the multiple-procedure reduction affect 32997?
For procedures performed in the same session, CMS pays the highest-valued procedure in full and other procedures at 50%. Which procedure receives the reduction depends on the relative values of the services reported.
Can an assistant or co-surgeon be reported for this procedure?
Medicare does not pay an assistant at surgery for 32997. Co-surgeons and team surgery are not permitted.
What care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care.
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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