CPT 32098 Open Pleural Biopsy Reimbursement | OpenPayer

Summary & Overview

CPT 32098: Open Surgical Pleural Biopsy

CPT code 32098 denotes an open surgical procedure to access the pleural cavity and obtain one or more biopsies of the pleura. This code captures invasive diagnostic sampling of the pleural lining and is used in cases where less invasive methods (for example, thoracentesis or closed needle biopsy) are inadequate or contraindicated. The procedure has national relevance for thoracic surgery, pulmonology, and oncology pathways when tissue diagnosis of pleural disease is required.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing-focused overview that covers the service context, typical sites of care, common modifiers used with this code, and where CPT code 32098 fits within diagnostic workflows for pleural disease. The publication summarizes typical utilization scenarios, reimbursement and coding considerations at a national level, and related service-level context. Data not available in the input for payer-specific rates, linked ICD-10 diagnoses, associated taxonomies, and related codes are noted as unavailable. This resource is intended to clarify coding meaning and operational context for clinicians, coding professionals, and policy analysts.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 32098pleural biopsythoracic surgerydiagnostic procedurehospital servicessurgical biopsyprocedural codingpulmonology

Billing Code Overview

CPT code 32098 describes an open surgical incision into the pleural space with one or more pleural biopsies. The procedure involves creating a surgical opening in the chest wall to access the pleural cavity and obtain tissue samples from the pleura for diagnostic evaluation.

Service type: Open surgical pleural biopsy

Typical site of service: Operating room or procedural suite in a hospital inpatient or outpatient setting

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old smoker who presents with progressive dyspnea, pleuritic chest pain, and an unexplained pleural effusion on chest radiograph and chest CT. After diagnostic thoracentesis is non-diagnostic or cytology is inconclusive, the thoracic surgeon schedules an open pleural biopsy to obtain wedge biopsies of the parietal and/or visceral pleura for histopathology and culture. The procedure is performed in an operating room under general anesthesia with single-lung ventilation when indicated. Intraoperative steps include a surgical incision (thoracotomy or limited open approach), entry into the pleural cavity, inspection, and targeted biopsies of abnormal pleural surfaces. Specimens are sent for histology, immunohistochemistry, and microbiology. Postoperative care includes chest tube placement if necessary, chest radiograph to confirm lung re-expansion, analgesia, and monitoring for pneumothorax or bleeding. Typical indications include suspected malignant pleural disease, pleural tuberculosis, unexplained recurrent pleural effusion, or persistent pleuritis unresponsive to medical therapy.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the physician professional portion for services that have a separate technical component (rare for open surgical procedures but used if facility bills technical portion).

CPT 32141: Thoracotomy for Bullectomy or Bulla Plication

32100-THORACOTOMY-WITH

CPT 32100: Thoracotomy with Exploration

CPT-32220-TOTAL-DECORTICATION-PLEURAL-RIND-REMOVAL

CPT 32220: Total Decortication, Removal of Pleural Rind

CPT-32035-THORACOSTOMY-RIB-EXCISION-EMPYEMA

CPT 32035: Thoracostomy and Rib Excision for Empyema

CPT-32160-OPEN-CHEST-CARDIAC-MASSAGE-EMERGENCY-RESUSCITATION

CPT 32160: Open-Chest Cardiac Massage for Cardiac Arrest

CPT-32124-THORACOTOMY-PNEUMONOLYSIS

CPT 32124: Thoracotomy with Pneumonolysis

CPT-32200-OPEN-DRAINAGE-PULMONARY-ABSCESS

CPT 32200: Open Drainage of Pulmonary Abscess or Cyst

CPT-32215-SURGICAL-PLEURAL-ADHESION-ABRASION-FOR-RECURRENT-PNEUMOTHORAX

CPT 32215: Surgical Abrasion for Recurrent Pneumothorax

CPT-32036-THORACOSTOMY-EVACUATION-OF-EMPYEMA-SKIN-FLAP

CPT 32036: Thoracostomy for Evacuation of Empyema with Skin Flap

CPT-32120-THORACOTOMY-SURGICAL-RE-EXPLORATION

CPT 32120: Thoracotomy for Surgical Re-exploration

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Taxonomy Code	Specialty	Notes
Data not available in the input.	Thoracic Surgery / Cardiothoracic Surgery	This specialty most commonly performs open pleural biopsy procedures.
Data not available in the input.	General Surgery	General surgeons with thoracic experience may perform pleural biopsies.
Data not available in the input.	Pulmonology (Interventional Pulmonology)	Interventional pulmonologists commonly perform pleural procedures, though open surgical biopsy is less frequent compared with thoracoscopic approaches.
Data not available in the input.	Otolaryngology - Head & Neck Surgery	Rarely involved; included for completeness when pleural access is part of multidisciplinary care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Malignant pleural effusion (e.g., metastatic disease)	Open pleural biopsy is indicated when pleural malignancy is suspected and less invasive sampling is non-diagnostic.
Data not available in the input.	Pleural effusion, unspecified	Diagnostic evaluation when effusion etiology is unclear after thoracentesis.
Data not available in the input.	Pleural tuberculosis	When microbiologic confirmation requires tissue biopsy for histology and culture.
Data not available in the input.	Empyema or complicated parapneumonic effusion	Surgical biopsy may be combined with debridement or decortication if indicated.
Data not available in the input.	Pleural thickening/pleuritis	Persistent inflammation or fibrosis requiring tissue diagnosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32096`	Thoracoscopy, surgical; with lung biopsy(es), single or multiple	Minimally invasive thoracoscopic approach that may be performed instead of an open pleural biopsy for tissue diagnosis.
`32502`	Tube thoracostomy, includes water seal (e.g., chest tube) with or without suction; initial insertion	Often performed before, during, or after open pleural biopsy when drainage or postoperative chest tube is required.
`32666`	Thoracotomy with decortication, with or without pleurectomy	Performed for more extensive pleural disease; an open pleural biopsy may be a component of or precursor to a more extensive decortication.
`32550`	Biopsy, pleura; percutaneous needle	A less invasive diagnostic alternative; performed when percutaneous approach is feasible and results are non-diagnostic leading to open biopsy.
`31750`	Bronchoscopy, rigid or flexible, diagnostic	May be performed in the same diagnostic workup to evaluate endobronchial lesions or obtain additional tissue for staging when malignancy is suspected.

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