2015 Thoracic Surgery
Medicare Reimbursement Coding Guide
Effective January 1, 2015
MEDICARE NATIONAL AVERAGE RATES AND ALLOWABLES
(NOT ADJUSTED FOR GEOGRAPHY)
Physician
CPT™*
HCPCS
Code
Procedure Description
*MPFS
(CF=$35.7547)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUPATIENT
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
DIAGNOSTIC
32096
Thoracotomy, with diagnostic biopsy(ies) of lung infiltrate(s)
(eg, wedge, incisional), unilateral
$835.59
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32097
Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or
mass(es) (eg, wedge, incisional), unilateral
$835.59
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32098
Thoracotomy, with biopsy(ies) of pleura
$791.97
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32100
Thoracotomy; with exploration
$839.88
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$90.82 / $155.18
0005
Level II Needle
Biopsy/Aspiration
Except Bone
Marrow
Biopsy, lung or mediastinum, percutaneous needle
$107.98 /
$457.66
0005
Level II Needle
Biopsy/Aspiration
Except Bone
Marrow
32505
Thoracotomy; with therapeutic wedge resection (eg, mass,
nodule), initial
$967.88
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32506
Thoracotomy; with therapeutic wedge resection (eg, mass or
nodule), each additional resection, ipsilateral (List separately in
addition to code for primary procedure)
$163.76
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32507
Thoracotomy; with diagnostic wedge resection followed by
anatomic lung resection (List separately in addition to code for
primary procedure)
$163.40
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32601
Thoracoscopy, diagnostic (separate procedure); lungs,
pericardial sac, mediastinal or pleural space, without biopsy
$320.36
0069
Thoracoscopy
$3,073.86
Not reimbursed
in ASC by
Medicare
32604
Thoracoscopy, diagnostic (separate procedure); pericardial sac,
with biopsy
$503.43
0069
Thoracoscopy
$3,073.86
Not reimbursed
in ASC by
Medicare
32606
Thoracoscopy, diagnostic (separate procedure); mediastinal
space, with biopsy
$479.83
0069
Thoracoscopy
$3,073.86
Not reimbursed
in ASC by
Medicare
32400
Biopsy, pleura; percutaneous needle
32405
$1,052.63
$576.80
$1,052.63
$576.80
Page 1 of 5
2015 Reimbursement Guide
Thoracic Surgery
Page 2 of 5
Physician
CPT™*
HCPCS
Code
Procedure Description
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUPATIENT
*MPFS
(CF=$35.7547)
Fac/Non-Fac
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
32607
Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s)
(eg, wedge, incisional), unilateral
$321.08
0069
Thoracoscopy
$3,073.86
Not reimbursed
in ASC by
Medicare
32608
Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or
mass(es) (eg, wedge, incisional), unilateral
$394.02
0069
Thoracoscopy
$3,073.86
Not reimbursed
in ASC by
Medicare
32609
Thoracoscopy; with biopsy(ies) of pleura
$269.59
0069
Thoracoscopy
$3,073.86
Not reimbursed
in ASC by
Medicare
32666
Thoracoscopy, surgical; with therapeutic wedge resection (eg,
mass, nodule), initial unilateral
$904.59
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32667
Thoracoscopy, surgical; with therapeutic wedge resection (eg,
mass or nodule), each additional resection, ipsilateral (List
separately in addition to code for primary procedure)
$164.11
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32668
Thoracoscopy, surgical; with diagnostic wedge resection
followed by anatomic lung resection (List separately in addition
to code for primary procedure)
$163.76
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$1,517.79
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
EXCISION
32110
Thoracotomy; with control of traumatic hemorrhage and/or
repair of lung tear
32120
Thoracotomy; for postoperative complications
$902.09
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32140
Thoracotomy; with cyst(s) removal, includes pleural procedure
when performed
$1,035.46
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32141
Thoracotomy; with resection-plication of bullae, includes any
pleural procedure when performed
$1,582.86
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32150
Thoracotomy; with removal of intrapleural foreign body or fibrin
deposit
$1,044.75
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32151
Thoracotomy; with removal of intrapulmonary foreign body
$1,050.47
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32160
Thoracotomy; with cardiac massage
$817.35
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32440
Removal of lung, pneumonectomy;
$1,624.34
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32442
Removal of lung, pneumonectomy; with resection of segment
of trachea followed by broncho-tracheal anastomosis (sleeve
pneumonectomy)
$3,202.91
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32445
Removal of lung, pneumonectomy; extrapleural
$3,693.10
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32480
Removal of lung, other than pneumonectomy; single lobe
(lobectomy)
$1,534.59
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32482
Removal of lung, other than pneumonectomy; 2 lobes
(bilobectomy)
$1,645.79
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32484
Removal of lung, other than pneumonectomy; single segment
(segmentectomy)
$1,493.83
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32486
Removal of lung, other than pneumonectomy; with
circumferential resection of segment of bronchus followed by
broncho-bronchial anastomosis (sleeve lobectomy)
$2,447.05
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32488
Removal of lung, other than pneumonectomy; with all
remaining lung following previous removal of a portion of lung
(completion pneumonectomy)
$2,512.13
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32491
Removal of lung, other than pneumonectomy; with resectionplication of emphysematous lung(s) (bullous or non-bullous) for
lung volume reduction, sternal split or transthoracic approach,
includes any pleural procedure, when performed
$1,536.02
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Resection and repair of portion of bronchus (bronchoplasty)
when performed at time of lobectomy or segmentectomy (List
separately in addition to code for primary procedure)
$255.29
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Thoracotomy; with therapeutic wedge resection (eg, mass,
nodule), initial
$967.88
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+325011
32505
2015 Reimbursement Guide
Thoracic Surgery
Page 3 of 5
Physician
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUPATIENT
CPT™*
HCPCS
Code
Procedure Description
*MPFS
(CF=$35.7547)
Fac/Non-Fac
32506
Thoracotomy; with therapeutic wedge resection (eg, mass or
nodule), each additional resection, ipsilateral (List separately in
addition to code for primary procedure)
$163.76
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32507
Thoracotomy; with diagnostic wedge resection followed by
anatomic lung resection (List separately in addition to code for
primary procedure)
$163.40
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32650
Thoracoscopy, surgical; with pleurodesis (eg, mechanical or
chemical)
$690.07
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32651
Thoracoscopy, surgical; with partial pulmonary decortication
$1,139.14
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32652
Thoracoscopy, surgical; with total pulmonary decortication,
including intrapleural pneumonolysis
$1,725.88
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32653
Thoracoscopy, surgical; with removal of intrapleural foreign
body or fibrin deposit
$1,099.46
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32654
Thoracoscopy, surgical; with control of traumatic hemorrhage
$1,187.41
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32655
Thoracoscopy, surgical; with resection-plication of bullae,
includes any pleural procedure when performed
$991.84
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32656
Thoracoscopy, surgical; with parietal pleurectomy
$833.44
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32658
Thoracoscopy, surgical; with removal of clot or foreign body
from pericardial sac
$744.41
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32659
Thoracoscopy, surgical; with creation of pericardial window or
partial resection of pericardial sac for drainage
$760.50
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32661
Thoracoscopy, surgical; with excision of pericardial cyst, tumor,
or mass
$832.73
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32662
Thoracoscopy, surgical; with excision of mediastinal cyst, tumor,
or mass
$928.55
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32663
Thoracoscopy, surgical; with lobectomy (single lobe)
$1,455.93
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32664
Thoracoscopy, surgical; with thoracic sympathectomy
$884.57
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32665
Thoracoscopy, surgical; with esophagomyotomy (Heller type)
$1,287.88
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
32666
Thoracoscopy, surgical; with therapeutic wedge resection (eg,
mass, nodule), initial unilateral
$904.59
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+326672
Thoracoscopy, surgical; with therapeutic wedge resection (eg,
mass or nodule), each additional resection, ipsilateral (List
separately in addition to code for primary procedure)
$164.11
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+326683
Thoracoscopy, surgical; with diagnostic wedge resection
followed by anatomic lung resection (List separately in addition
to code for primary procedure)
$163.76
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$991.48
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
HERNIA
32800
Repair lung hernia through chest wall
ROBOTIC ASSISTANCE
S2900‡
Surgical techniques requiring use of robotic surgical system (list
separately in addition to code for primary procedure)
Not Valid for Medicare
NOTES:
• 1Use 32501 in conjunction with 32480, 32482, 32484.
• 2Report 32667 only in conjunction with 32666.
• 3Report 32668 in conjunction with 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488, 32503, 32504, 32663, 32669, 32670, 32671.
• ‡S-Codes are not valid for Medicare payment
• Multiple Procedure Discounting – Multiple surgical procedures furnished during the same operative session are discounted. 50% is paid for any other surgical procedure(s) performed at the same time.
• MPFS Facility allowables and ASC rates include patient cost-sharing (coinsurance and deductibles). HOPPS rates include patient cost-sharing (co-payments and deductibles). These amounts are national averages and are not adjusted for
geography.
• The above 2015 MPFS payment rates reflect policies finalized in the CY 2015 Medicare Physician Fee Schedule Final Rule, CMS-1612-FC that was placed on display at the Federal Register on October 31st, 2014. These rates reflect a zero
percent update effective January 1st, 2015 through March 31st, 2015, as provided for by the Protecting Access to Medicare Act of 2014. The CF published in the January update is $35.7547. Current law requires physician fee schedule
rates to be reduced by an average of 21.2 percent from the CY 2014 rates because of the existing SGR factor used to calculate the conversion factor. In most prior years, Congress has taken action to avert a large reduction in MPFS rates
before they went into effect. Without further congressional action, this updated CF is due to expire on March 31st, 2015.
• The above National Average APC and ASC Rates represent the reimbursement amounts paid directly to the facility for the technical portion of the procedure. The Physician (surgeon) would separately receive the professional fee (MPFS
Allowable) for the procedure performed.
• Rates referenced in this guide do not reflect Sequestration, automatic reductions in federal spending that result in a 2% across-the-board reduction to all Medicare rates.
2015 Reimbursement Guide
Thoracic Surgery
Page 4 of 5
REFERENCES:
‡ CMS 2015 Alpha-Numeric HCPCS File Updated – 11/12/2014
*PFS Relative Value Files, RVU15B (2-13-15), effective April 1, 2015
** CMS-1613-CN (2-24-15) HOPPS Addendum A and B, effective January 1, 2015
***CMS-1613-CN (2-24-15) ASC Addendum AA, BB, DD1, DD2, and EE, effective January 1, 2015
ICD-9-CM VOLUME 3 HOSPITAL PROCEDURE CODES
Procedure
Code*
Description
DIAGNOSTIC
32.20
Thorascopic excision of lesion or tissue of lung
32.29
Other local excision or destruction of lesion or tissue of lung
32.30
Thoracoscopic segmental resection of lung
32.39
Other and unspecified segmental resection of lung
32.41
Thoracoscopic lobectomy of lung
32.49
Other lobectomy of lung
33.20
Thoracoscopic lung biopsy
33.24
Closed [endoscopic] biopsy of bronchus
33.25
Open biopsy of bronchus
33.26
Closed [percutaneous] [needle] biopsy of lung
33.27
Closed endoscopic biopsy of lung
33.28
Open biopsy of lung
33.29
Other diagnostic procedures on lung or bronchus
Excision
32.20
Thorascopic excision of lesion or tissue of lung
32.29
Other local excision or destruction of lesion or tissue of lung
32.30
Thoracoscopic segmental resection of lung
32.39
Other and unspecified segmental resection of lung
32.41
Thoracoscopic lobectomy of lung
32.49
Other lobectomy of lung
32.50
Thoracoscopic pneumonectomy
32.59
Other and unspecified pneumonectomy
32.6
Radical dissection of thoracic structures
32.9
Other excision of lung
Robotic Assistance
17.41
Open robotic assisted procedure
17.42
Laparoscopic robotic assisted procedure
17.43
Percutaneous robotic assisted procedure
17.44
Endoscopic robotic assisted procedure
17.45
Thoracoscopic robotic assisted procedure
17.49
Other and unspecified robotic assisted procedure
NOTES:
The ICD-9-CM Hospital Procedure Codes listed above may be used in the MS-DRG Classifications (See Inpatient DRG Payment Rates Table)
The appropriate MS-DRG classification is also dependent on the diagnosis code, demographics, sex and possible co-conditions.
REFERENCES:
*2015 Hospital ICD-9-CM Volume 3, 9th Revision, Clinical Modification, Sixth Edition
2015 Reimbursement Guide
Thoracic Surgery
Page 5 of 5
INPATIENT DRG PAYMENT RATES
MS-DRG*
MS-DRG Title
Arithmetic Mean
Length of Stay
(Days)
National
Average
Payment**
DIAGNOSTIC
163
Major Chest Procedures w MCC
13.2
$29,559.08
164
Major Chest Procedures w CC
6.6
$15,275.20
165
Major Chest Procedures w/o CC/MCC
3.9
$10,700.28
166
Other Respiratory System O.R. Procedures w MCC
11.1
$21,500.39
167
Other Respiratory System O.R. Procedures w CC
6.6
$11,638.75
168
Other Respiratory System O.R. Procedures w/o CC/MCC
3.9
$7,805.57
EXCISION
163
Major Chest Procedures w MCC
13.2
$29,559.08
164
Major Chest Procedures w CC
6.6
$15,275.20
165
Major Chest Procedures w/o CC/MCC
3.9
$10,700.28
166
Other Respiratory System O.R. Procedures w MCC
11.1
$21,500.39
167
Other Respiratory System O.R. Procedures w CC
6.6
$11,638.75
168
Other Respiratory System O.R. Procedures w/o CC/MCC
3.9
$7,805.57
NOTES:
*One DRG per patient is assigned to each inpatient stay.
REFERENCES:
** FY 2015 Final Rule, Federal Register, Vol. 79, No. 163, Friday, August 22, 2014 and Correction Notice, Federal Register, Vol. 79, No. 192, Friday, October 3, 2014, Table 1A-1E and Table 5. National Average Payment Rate is based upon the
National Average Operating Standardized Amount ($5,437.85) plus the Capital Standard Federal Payment Rate ($434.97)..
Disclaimer:
The information contained in this guide is provided to help you understand the reimbursement process. It is not intended to increase or maximize reimbursement by any
payer. We strongly recommend that providers consult their payer organization with regard to local reimbursement policies. The information contained in this guide is
provided for information purposes only and represents no statement, promise or guarantee by Covidien concerning levels of reimbursement, payment or charge.
Similarly, all CPT HCPCS and ICD-9-CM codes are supplied for information purposes only and represent no statement, promise or guarantee by Covidien that these
codes will be appropriate or that reimbursement will be made. ICD-9-CM is based on the official version of the World Health Organization’s Ninth Revision, International
Classification of Diseases. CPT codes and descriptions only are copyright 2013 American Medical Association. All rights reserved.
CPT does not include fee schedules, relative values or related listings. The source for this information is the Centers for Medicare and Medicaid Services (CMS). Reimbursement rates reflected in this guide are Medicare National Average rates as published by CMS at the time of printing, and do not reflect provider payment adjustment
factors such geographic adjustment, participation as a Disproportionate Share or Teaching Hospital, participation in the CMS Shared Service (ACO) program, or Value
Base Purchasing adjustments. The content provided by CMS is updated frequently. It is the responsibility of the health services provider to confirm the appropriate coding
required by their local Medicare Administrative Contractors (MACs), carriers, fiscal intermediaries and commercial payers.
All Current Procedural Terminology (CPT) five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines and other material are copyright © 2014
American Medical Association. All rights reserved.
Code associations and values have been reviewed and validated by NMD Healthcare, Inc.
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