No office rate
Use 32659 for thoracoscopic drainage of the pericardial sac. Use 32658 when the thoracoscopic work removes a foreign body from the sac.
On this page
CMS RVU26D · Effective 2026-10-01
32659 Pericardial drainage Medicare reimbursement rates in Vermont
Report this service when a surgeon uses thoracoscopy to drain fluid from the pericardial sac, commonly for a pericardial effusion. Compare 32659 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 32659 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
$666.13
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 32659: Thoracoscopic pericardial sac drainage
Report this service when a surgeon uses thoracoscopy to drain fluid from the pericardial sac, commonly for a pericardial effusion.
A thoracic surgeon uses a thoracoscope to reach and drain fluid from the sac surrounding the heart. In an operating room, this may involve creating a pericardial window so fluid can drain into the chest. The service is used for pericardial effusions requiring surgical drainage; it is distinct from needle drainage through the skin.
Report 32659 when the operative work is thoracoscopic drainage of the pericardial sac. The operative note should establish the thoracoscopic approach, the pericardial fluid or collection treated, and the drainage performed; distinguish this from removal of a foreign body or excision of pericardium. CMS assigns a 90-day global period, including 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. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 32659
- 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 RVU11.64 · 54%
- Practice expense (office) RVU6.90 · 32%
- Malpractice RVU2.91 · 14%
565
Medicare services in 2024 · #3452 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.
32659 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
33016 is percutaneous pericardiocentesis with imaging guidance. Choose 32659 when the surgeon performs drainage through a thoracoscopic approach.
No office rate
33025 describes creation of a pericardial window or partial resection for drainage. 32659 identifies thoracoscopic drainage.
Compare 32659 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
$666.13
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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 32659 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
3,755
- Code
- 32659
- Physician work
- 11.64
- Practice expense
- 6.90
- Malpractice
- 2.91
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.64 | × 1.000 | 11.6400 |
| Practice expense | 6.90 | × 0.990 | 6.8310 |
| Malpractice | 2.91 | × 0.506 | 1.4725 |
| Total RVUs | 19.9435 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$666.13
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.64 | 1 |
| Practice expense | 6.9 | 0.99 |
| Malpractice | 2.91 | 0.506 |
(11.64 × 1 + 6.9 × 0.99 + 2.91 × 0.506) × $33.4009 = $666.13
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.
32659 billing questions
How is 32659 different from pericardiocentesis?
32659 is for surgical drainage performed through a thoracoscopic approach. Pericardiocentesis uses percutaneous needle or catheter access rather than thoracoscopic surgery.
How is 32659 different from 32658?
32659 covers drainage of the pericardial sac. 32658 is for thoracoscopic removal of a foreign body from that sac.
Does 32659 include creation of a pericardial window?
A thoracoscopic window may be part of the drainage procedure. The operative note should describe the approach and the work performed.
What documentation supports reporting 32659?
Document the thoracoscopic approach, the pericardial collection treated, and the drainage performed. The note should make clear that the service was drainage rather than foreign-body removal or pericardiectomy.
What global period applies to 32659?
CMS assigns a 90-day global period. It includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be reported for 32659?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this pericardial-sac service.
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.
3,75232655,,Thoracoscopy resect bullae,A,,15.77,7.70,NA,7.70,,3.95,27.42,27.42,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75332656,,Thoracoscopy w/pleurectomy,A,,12.93,7.16,NA,7.16,,3.24,23.33,23.33,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75432658,,Thoracoscopy w/sac fb remove,A,,11.42,6.53,NA,6.53,,2.87,20.82,20.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75532659,,Thoracoscopy w/sac drainage,A,,11.64,6.90,NA,6.90,,2.91,21.45,21.45,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,7563265F,,Rna tstng hepc vir ord/docd,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
3,75732661,,Thoracoscopy w/pericard exc,A,,13.00,6.84,NA,6.84,,3.26,23.10,23.10,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,75832662,,Thoracoscopy w/mediast exc,A,,14.62,7.49,NA,7.49,,3.66,25.77,25.77,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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