CPT 32445 Radical Pneumonectomy Reimbursement | OpenPayer

Summary & Overview

CPT 32445: Radical Pneumonectomy with Pleural Tumor Resection

CPT code 32445 represents a radical pneumonectomy with removal of any visible tumor from the parietal pleural lining over the chest wall, pericardium, and diaphragm. This code captures a high-acuity, oncologic thoracic surgical service used when disease involves the lung and adjacent pleural surfaces and complete surgical resection is the intended goal. Nationally, services coded with CPT 32445 are important for measuring utilization of definitive surgical management for advanced or locally invasive thoracic malignancy and for informing resource planning in tertiary surgical centers.

Key payers evaluated include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the procedure, typical settings of care, and which payers commonly reimburse inpatient thoracic oncology surgery nationally. The report outlines benchmarking parameters and policy-relevant items such as inpatient site-of-service expectations, common modifier usage (Data not available in the input), and gaps where standardized reporting is limited.

This publication aims to help coding professionals, hospital billers, and policy analysts quickly understand the code’s clinical scope, expected care setting, and areas where payer policy and coding detail tend to drive billing and authorization practices. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 32445thoracic surgerypneumonectomyoncologic surgeryinpatient surgerypleurectomybilling and codingsurgical oncologyhospital operating room

Billing Code Overview

CPT code 32445 describes a surgical procedure in which the provider removes an entire lung (pneumonectomy) and excises any visible cancer on the parietal pleural lining of the chest, heart, and diaphragm. This is an extensive oncologic thoracic surgery performed to treat malignancy involving the lung and contiguous pleural surfaces.

Service type: Major surgical excision (radical pneumonectomy with pleurectomy/pleural tumor debulking)
Typical site of service: Inpatient hospital operating room with postoperative inpatient care (acute care hospital).

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old with a history of heavy smoking who presents with progressive dyspnea, chronic cough, and unintentional weight loss. Imaging (chest CT and PET-CT) demonstrates a large, FDG-avid mass occupying the right hemithorax with suspected invasion of the visceral pleura and discrete nodularity along the parietal pleura. Tissue diagnosis from bronchoscopy or CT-guided biopsy confirms non–small cell lung carcinoma. After multidisciplinary review (thoracic surgery, medical oncology, radiation oncology, pulmonology), the patient is scheduled for a pneumonectomy with pleurectomy/decortication to remove the entire affected lung and visible tumor involvement of the parietal pleura, diaphragm, or pericardial surface.

Preoperative workflow includes full cardiopulmonary evaluation (PFTs, cardiology clearance, arterial blood gas, and echocardiogram), anesthesiology assessment, and oncologic staging. Intraoperative steps include general endotracheal anesthesia with single-lung ventilation, thoracotomy or sternotomy approach as indicated, resection of the entire lung, inspection and resection of visible pleural disease, control of hilar structures, possible pericardial or diaphragmatic resection/repair, chest tube placement, and hemostasis. Postoperative care involves ICU monitoring, chest tube management, pain control, pulmonary toilet, and coordination for adjuvant therapy if indicated.

Typical site of service: Inpatient hospital operating room with immediate postoperative ICU or step-down admission.

Service type: Major surgical procedure — thoracic oncologic resection (pneumonectomy with pleurectomy/pleural tumor debulking).

Coding Specifications

Modifier	Description	When to Use

CPT 32506: Add-on Open Wedge Resection, Additional Lung Excision

CPT-32491-EMPHYSEMA-LUNG-TISSUE-RESECTION-STERNAL-TRANSTHORACIC

CPT 32491: Resection of Emphysematous Lung Tissue via Sternal or Transthoracic Approach

CPT-32540-EMPYEMA-EXCISION-PLEURAL-LINING

CPT 32540: Excision of Empyema with Pleural Lining

CPT-32484-SEGMENTAL-LUNG-RESECTION

CPT 32484: Segmental Lung Resection

CPT-32507-THORACIC-WEDGE-RESECTION-WITH-LUNG-RESECTION-ADD-ON

CPT 32507: Thoracic Wedge Resection With Lung Resection, Add-On

CPT-32482-BILOBECTOMY-TWO-LOBE-LUNG-RESECTION

CPT 32482: Removal of Two Lung Lobes (Bilobectomy)

CPT-32486-LUNG-RESECTION-WITH-BRONCHIAL-REPAIR

CPT 32486: Lung Resection with Bronchial Repair

CPT-32440-THORACOTOMY-PNEUMONECTOMY-ENTIRE-LUNG-REMOVAL

CPT 32440: Thoracotomy for Removal of Lung

CPT-32488-COMPLETION-PNEUMONECTOMY-REMAINING-LUNG-TISSUE

CPT 32488: Removal of Remaining Lung Tissue After Prior Lobectomy/Segmentectomy

CPT-32501-BRONCHIAL-REPAIR-POST-LOBECTOMY-SEGMENTECTOMY

CPT 32501: Bronchial Repair After Lobectomy or Segmentectomy

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Taxonomy Code	Specialty	Notes
2080P0206X	Thoracic Surgery	Primary specialty performing pneumonectomy and pleural resection.
2080P0205X	General Surgery	General surgeons with thoracic training may perform complex lung resections in some centers.
207RH0000X	Pulmonary Disease	Pulmonologists are involved in diagnosis, staging, and bronchoscopic procedures preoperatively.
207L00000X	Cardiothoracic Surgery	Cardiothoracic surgeons perform resections when cardiac/mediastinal involvement is present.
207K00000X	Surgical Oncology	Surgical oncologists participate in multidisciplinary cancer resections and complex reconstructions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Primary diagnosis indicating lung cancer warranting major resection such as pneumonectomy.
`C34.11`	Malignant neoplasm of upper lobe, right bronchus or lung	Common tumor location that may necessitate right pneumonectomy when extensive.
`C34.12`	Malignant neoplasm of middle lobe, right bronchus or lung	Tumor in middle lobe that can extend and require more extensive resection in advanced disease.
`C34.31`	Malignant neoplasm of upper lobe, left bronchus or lung	Left-sided tumors involving the upper lobe that may be treated with pneumonectomy if extensive.
`C78.2`	Secondary malignant neoplasm of respiratory and digestive organs (pulmonary metastasis)	Pulmonary metastatic disease occasionally requires resection when solitary and resectable.
`C90.12`	Multiple myeloma, in relapse — (example metastatic pleural disease)	Represents systemic malignancies that can involve pleura prompting pleurectomy in select cases.
`J91.0`	Malignant pleural effusion	Presence of malignant pleural effusion with pleural tumor implants often encountered with pleural resection/decortication.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32551`	Excision of lung, partial lobectomy; single lobe	Performed when a lesser resection (lobectomy) is indicated instead of a full pneumonectomy; alternative surgical option based on tumor size/location.
`32663`	Thoracotomy; decortication, removal of restrictive pleural rind, without lobectomy/pneumonectomy	May be performed in conjunction with pleural stripping or when pleural disease is primary; addresses pleural tumor burden.
`32570`	Open thoracotomy for lung biopsy, wedge resection	Performed for diagnostic wedge biopsies or limited resections prior to or instead of pneumonectomy.
`37620`	Pulmonary artery or intrathoracic vessel control (thoracic vascular control)	Used when major vascular control or reconstruction is required during pneumonectomy.
`99223`	Initial hospital care, high severity	Typical inpatient evaluation and management code for the perioperative admission for major thoracic surgery.
`32830`	Thoracoscopy, diagnostic, with or without biopsy	May be performed preoperatively for staging or intraoperatively for inspection of pleural surfaces; less invasive option for assessment.

`00`	No modifier — standard reporting	Use when no specific modifier applies; routine claim submission.
`11`	Office/clinic or professional component? (Note: CMS uses `-11` in some payor systems to indicate usual/expected service)	Use when reporting the primary, unaltered service as performed by the billing practitioner per payer requirements.
`22`	Increased procedural services	Use when work required is substantially greater than typically required for `32445` (extensive adhesiolysis, unanticipated major reconstruction).
`23`	Unusual anesthesia — patient condition	Use when anesthesia is unusually extensive due to patient's preexisting condition making anesthesia high risk.
`26`	Professional component	Use when separating professional (surgeon) component from technical/hospital charges where payer requires split billing.
`50`	Bilateral procedure	Not typically applicable to `32445` (single lung resection); include only when bilateral thoracic procedures are performed (rare).
`51`	Multiple procedures	Use when `32445` is reported along with additional distinct surgical procedures during the same operative session.
`52`	Reduced services	Use when the procedure is partially performed or discontinued (e.g., aborted pneumonectomy due to unresectable disease).
`53`	Discontinued procedure	Use when the operation is started but discontinued for patient safety before completion.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct portions of the operation (e.g., thoracic surgeon and cardiac surgeon for pericardial resection).
`63`	Procedure performed on infants less than 4 kg	Uncommon for this adult oncologic procedure; not typically used.
`66`	Surgical team approach	Use when an established surgical team approach is required for complex thoracic resections.
`80`	Assistant surgeon	Use when a surgical assistant (not a co-surgeon) assists during the procedure.
`81`	Minimum assistant surgeon	Use when minimal assistant participation is documented.

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