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    v1.0.28
    OpenPayerBilling CodesThoracoscopy (Video-assisted thoracic surgery [VATS]) on the Lungs and PleuraCPT cpt-32665-thoracoscopic-esophageal-myotomy
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    CPT 32665: Thoracoscopic Esophageal Myotomy

    Medicare pays $1175 on average nationally for this procedure.

    CPT code 32665 describes a thoracoscopic procedure in which a thoracoscope is used to access the chest and incise the muscular wall of the esophagus (esophageal myotomy); this is a thoracoscopic surgical esophageal myotomy procedure, typically classified as a thoracic surgical service and most often performed in an operating room or other inpatient/ambulatory surgical facility under general anesthesia.

    For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 45–65-year-old presenting with progressive dysphagia to solids and liquids, chest discomfort, and episodes of food impaction. Diagnostic workup includes esophagoscopy, barium swallow, and esophageal manometry that identify achalasia or a thickened lower esophageal muscular wall with outflow obstruction. After evaluation by thoracic surgery or an advanced endoscopist, the patient is scheduled for a thoracoscopic esophagomyotomy using a thoracoscope to access and incise the muscular layer of the esophagus to relieve functional obstruction.

    Pre-procedure workflow includes informed consent, anesthesia evaluation (general endotracheal anesthesia), prophylactic antibiotics per local protocol, and imaging review. Intraoperative steps include patient positioning in lateral decubitus, thoracoscopic port placement, identification of the esophagus, careful division of the muscular layer (myotomy) while preserving mucosa, intraoperative leak testing, and closure of thoracoscopic ports with appropriate drains if indicated. Postoperative workflow includes recovery in PACU, chest radiograph to evaluate lung expansion and rule out pneumothorax, monitoring for signs of leak or bleeding, pain control, and an incremental diet advancement guided by contrast swallow study when indicated. Typical site of service is an inpatient hospital operating room or ambulatory surgical center when clinically appropriate.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43280Esophagoscopy, flexible, transoral; diagnostic, with or without collection of specimen(s) by brushing or washingPreoperative diagnostic endoscopy to evaluate mucosa, rule out alternative pathology, and guide surgical planning.
    43284Esophagoscopy, rigid or flexible, with dilation of stricture; therapeuticMay be performed preoperatively for dilation of high-grade strictures or food impaction prior to definitive myotomy.
    39501Median sternotomy, for other than CABG; limited thoracic approachRelated thoracic access codes when alternative open approaches are required if thoracoscopy is converted to open.
    51702Complex cystourethroscopy with ureteroscopy (example unrelated)Data not available in the input.
    99223Initial hospital care, typically 70 minutes or moreInpatient postoperative evaluation and management for major thoracic surgery.

    Related Modifiers

    14 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Showing 1–10 of 14

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    2355S0801XSpeech-Language AssistantSpeech, Language and Hearing Service Providers · Specialist/Technologist
    133VN1101XGerontological Nutrition Registered DietitianAn individual who is a Specialist in Gerontological Nutrition and provides nutrition care to promote quality of life and optimal health for older adul…
    2080P0201XPediatric Allergy/Immunology PhysicianA pediatrician who specializes in the diagnosis and treatment of allergies, allergic reactions, and immunologic diseases in children.
    2081N0008XNeuromuscular Medicine (Physical Medicine & Rehabilitation) PhysicianA physician who specializes in neuromuscular medicine possesses specialized knowledge in the science, clinical evaluation and management of these diso…
    247ZC0005XClinical Laboratory Director (Non-physician)An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments o…

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    9 rows

    PolicyPayerEffective Date
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21
    Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_BlocksCigna2026-05-15
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01

    Related Codes

    CPT-32601-DIAGNOSTIC-THORACIC-ENDOSCOPY-LUNG-MEDIASTINUM-PLEURA

    CPT 32601: Diagnostic Thoracoscopic/Endoscopic Examination of Lung or Pleural Spaces

    CPT-32604-THORACOSCOPIC-PERICARDIAL-BIOPSY-ENDOSCOPIC-PERICARDIAL-SAMPLING

    CPT 32604: Thoracoscopic Pericardial Biopsy

    CPT-32606-THORACOSCOPIC-MEDIASTINAL-BIOPSY

    CPT 32606: Mediastinoscopy with Mediastinal Biopsy

    CPT-32607-VIDEO-ASSISTED-ENDOSCOPIC-LUNG-SAMPLING

    CPT 32607: Video-Assisted Endoscopic Sampling of Single Lung

    CPT-32608-VIDEO-ASSISTED-ENDOSCOPIC-LUNG-NODULE-BIOPSY

    CPT 32608: Video-Assisted Endoscopic Lung Nodule Biopsy

    CPT-32609-VIDEO-ASSISTED-PLEURAL-BIOPSY-THORACOSCOPIC

    CPT 32609: Pleural Biopsy, Video-Assisted Endoscopic Approach

    CPT-32650-THORACOSCOPIC-PLEURODESIS

    CPT 32650: Thoracoscopy-Assisted Pleurodesis

    CPT-32651-VIDEO-ASSISTED-PLEURAL-STRIPPING-THORACOSCOPIC-PLEURECTOMY

    CPT 32651: Video-Assisted Pleurectomy/Stripping of Parietal Pleura

    CPT-32652-THORACOSCOPIC-LUNG-DECORTICATION-VIDEO-ASSISTED

    CPT 32652: Video-Assisted Pleurectomy and Decortication

    CPT-32653-VIDEO-ASSISTED-THORACOSCOPIC-FOREIGN-BODY-REMOVAL

    CPT 32653: Video-Assisted Thoracoscopic Removal of Pleural Foreign Body

    Showing 1–10 of 28

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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