No office rate
Choose 32096 for infiltrative lung tissue and 32097 for a discrete lung nodule. The target documented by the surgeon distinguishes these open biopsy codes.
On this page
CMS RVU26D · Effective 2026-10-01
32096 Lung biopsy Medicare reimbursement rates in Vermont
Reports an open surgical wedge biopsy of lung tissue with infiltrative changes when tissue is needed to establish a diagnosis. Compare 32096 office and facility rates across CMS payment localities in Vermont.
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 32096 in Vermont?
Vermont 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
$707.22
1 of 1 localities have a supported rate.
Payment area: Vermont
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 32096: Open lung infiltrate wedge biopsy
Reports an open surgical wedge biopsy of lung tissue with infiltrative changes when tissue is needed to establish a diagnosis.
The surgeon opens the chest and removes wedge samples from lung tissue showing infiltrative changes for diagnostic examination. A thoracic surgeon typically performs this operation in a hospital operating room when tissue is needed for pathologic evaluation, and sometimes for microbiologic studies. The target is an infiltrate rather than a discrete lung nodule or pleural tissue.
Select this code based on the tissue sampled and the open approach; document the infiltrative target, the biopsy performed, and the diagnostic purpose. It has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment does not apply, so modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 32096
- 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 RVU13.41 · 59%
- Practice expense (office) RVU6.14 · 27%
- Malpractice RVU3.33 · 15%
93
Medicare services in 2024 · #4933 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.
32096 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
32096 samples lung tissue; 32098 samples pleura. Identify the anatomic tissue submitted for biopsy.
No office rate
Both address biopsy of a lung infiltrate, but 32096 is the open approach and 32607 is the thoracoscopic approach.
$791.79
32408 describes percutaneous core needle sampling of lung or mediastinum; 32096 describes an open surgical wedge biopsy of lung tissue.
Compare 32096 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
Vermont →
Office / nonfacility
Unavailable
Facility
$707.22
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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 32096 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
3,686
- Code
- 32096
- Physician work
- 13.41
- Practice expense
- 6.14
- Malpractice
- 3.33
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.41 | × 1.000 | 13.4100 |
| Practice expense | 6.14 | × 0.990 | 6.0786 |
| Malpractice | 3.33 | × 0.506 | 1.6850 |
| Total RVUs | 21.1736 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$707.22
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.41 | 1 |
| Practice expense | 6.14 | 0.99 |
| Malpractice | 3.33 | 0.506 |
(13.41 × 1 + 6.14 × 0.99 + 3.33 × 0.506) × $33.4009 = $707.22
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.
32096 billing questions
When is 32096 selected instead of 32097?
Use 32096 when the open biopsy targets lung tissue with infiltrative changes. Code 32097 is for a discrete lung nodule target.
Does this code describe a pleural biopsy?
No. It describes biopsy of lung tissue; 32098 is the related open biopsy code for pleural tissue.
Can modifier 50 be reported for bilateral lung biopsies?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. 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 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.
3,6833200F,,Barium swallow test not req,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
3,68432035,,Thoracostomy w/rib resection,A,,11.01,8.01,NA,8.01,,2.76,21.78,21.78,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,68532036,,Thoracostomy w/flap drainage,A,,11.99,8.18,NA,8.18,,3.02,23.19,23.19,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,68632096,,Open wedge/bx lung infiltr,A,,13.41,6.14,NA,6.14,,3.33,22.88,22.88,0,090,0.10,0.76,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,68732097,,Open wedge/bx lung nodule,A,,13.41,6.32,NA,6.32,,3.32,23.05,23.05,0,090,0.10,0.76,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,68832098,,Open biopsy of lung pleura,A,,12.59,5.95,NA,5.95,,3.06,21.60,21.60,0,090,0.10,0.76,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,68932100,,Exploration of chest,A,,13.41,6.55,NA,6.55,,3.31,23.27,23.27,0,090,0.10,0.76,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817