Billing code 32650: PleurodesisMedicare rate & RVUs in Washington
Thoracoscopic pleurodesis creates adhesion between pleural surfaces, commonly to reduce recurrence of pneumothorax or manage recurrent pleural effusion.
CMS doesn’t publish an office rate for 32650 in Washington.
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 32650 covers
A thoracic surgeon performs this operation through a thoracoscope to make the visceral and parietal pleura adhere, using a mechanical or chemical technique. Common situations include recurrent pneumothorax and recurrent pleural effusion, including effusion associated with malignancy. The service is typically performed in an operating room or hospital setting under general anesthesia.
Report the code for the thoracoscopic pleurodesis itself, with the operative report identifying the indication, approach, and method used. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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 50% reduction. For a bilateral procedure reported with modifier 50, CMS pays at 150%. Assistant-at-surgery payment may be made; 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 32650 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $645.71 |
| Seattle (King Cnty) | Unavailable | $700.45 |
How the 32650 rate is calculated
Each of 32650’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 · 32650
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.56Practice expense 6.35Malpractice 2.56
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 32650
32650 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 32650
Pleurodesis
| 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 · 32650
Pleurodesis
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
32650 without 50 · national facility
$650.32
Pleurodesis
32650-50 · Bilateral: 150%
$975.48
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).
32650 compared with similar codes
Compare codes
32650 vs 32560 vs 32609 vs 32656: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 32560Chemical pleurodesis
- Code 32560 describes chemical pleurodesis through a chest tube. Use 32650 when the pleurodesis is performed with a thoracoscopic approach.
- 32609Pleural biopsy
- Code 32609 represents thoracoscopic pleural biopsy. It describes diagnostic tissue sampling, not pleural adhesion treatment.
- 32656Thoracoscopic pleurectomy
- Code 32656 describes thoracoscopic pleurectomy, which removes pleural tissue. Code 32650 is for creating pleural adhesion without coding the service as pleurectomy.
32650 billing questions
When should I report this instead of code 32560?
Report this code when pleurodesis is performed thoracoscopically. Code 32560 describes chemical pleurodesis delivered through a chest tube without a thoracoscopic approach.
How does this differ from thoracoscopic pleurectomy?
Pleurodesis brings the pleural surfaces together to form an adhesion. Pleurectomy removes pleural tissue and is a different operative approach.
Can a pleural biopsy be reported during the same operation?
A pleural biopsy may be performed for diagnostic evaluation during the encounter. Documentation should identify the biopsy site and its separate purpose; apply applicable coding edits when reporting both services.
What does the 90-day global period include?
It includes the day-before preoperative visit and related postoperative care for 90 days after surgery.
How is bilateral pleurodesis handled under the CMS payment facts?
For a bilateral procedure reported with modifier 50, CMS pays at 150%.
May an assistant surgeon be paid for this operation?
CMS permits assistant-at-surgery payment. Co-surgeon payment requires supporting documentation, while 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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