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CPT 32906: Rib Excision with Chest Wall Collapse and Bronchopleural Fistula Closure

CPT code 32906 represents an open thoracic surgical procedure in which ribs are excised to cause lateral collapse of the chest wall and pleural cavity, with concurrent closure of a bronchopleural fistula. This procedure is used for serious pleural and pulmonary conditions such as empyema, cavitary tuberculosis, and persistent bronchopleural fistula that have failed less invasive treatments. Nationally, CPT code 32906 is relevant to hospital-based thoracic surgery programs, inpatient surgical management strategies, and payer coverage policies for complex pleural procedures.

Key payers commonly involved when this service is billed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the operation, coding specifics, and the kinds of benchmarking and policy considerations that affect hospital reimbursement and utilization. The publication provides an overview of typical sites of service and service type, clarifies the clinical intent of the procedure, and summarizes typical modifiers and administrative considerations when available. Data not available in the input will be noted where applicable.

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Billing Code Overview

CPT code 32906 describes surgical excision of ribs to remove structural support around the lungs, producing lateral collapse of the chest wall and pleural cavity. The procedure is performed to treat conditions such as empyema, cavitary tuberculosis, or a bronchopleural fistula, and in this instance the surgeon also closes an existing bronchopleural fistula as part of the operation.

Service type: Open thoracic surgical procedure for pleural space obliteration and bronchopleural fistula repair
Typical site of service: Inpatient hospital operating room or thoracic surgery suite

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CPT 32906: Rib Excision with Chest Wall Collapse and Bronchopleural Fistula Closure

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Billing Code Overview

Service type: Open thoracic surgical procedure for pleural space obliteration and bronchopleural fistula repair
Typical site of service: Inpatient hospital operating room or thoracic surgery suite

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a chronic, loculated pleural space infection such as complex empyema or cavitary pulmonary tuberculosis complicated by a persistent bronchopleural fistula. The patient often presents with fever, pleuritic chest pain, persistent purulent drainage from a chest tube, and failure of medical management including prolonged antibiotics and chest tube drainage with or without fibrinolytics. Imaging (CT chest and chest radiographs) demonstrates an encapsulated pleural collection with thickened pleura and associated rib cage deformity or persistent air leak.

Preoperative workflow includes pulmonary and infectious disease consultation, optimization of nutrition and respiratory status, pleural sampling and microbiology, and informed consent explaining thoracostomy and rib resection with fistula closure. The procedure is typically performed in an operating room under general anesthesia with single-lung ventilation. The surgeon performs rib excision (thoracoplasty) to collapse the chest wall and obliterate the pleural space, and identifies and closes the bronchopleural fistula (may require direct suture repair, muscle flap, or synthetic patch). Postoperative care includes chest tube management, pain control, pulmonary toilet, targeted antimicrobials, and monitoring for recurrent air leak or infection. Typical site of service is an inpatient operating room in a tertiary hospital; ambulatory settings are not appropriate for this invasive thoracic procedure.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for `32906` due to extensive dissection, multiple rib resections, or complex fistula repair.
`23`	Unusual anesthesia	Use if significant, medically necessary anesthesia unrelated to the procedure is required (e.g., procedures performed under general anesthesia when local/regional would normally suffice) — rare for thoracoplasty.
`26`	Professional component	Use if reporting only the physician’s professional component of an associated diagnostic service (e.g., imaging interpretation) when billed separately.
`50`	Bilateral procedure	Use if bilateral thoracoplasty and bilateral bronchopleural fistula closure are performed (uncommon but possible).
`51`	Multiple procedures	Use when `32906` is billed with other unrelated procedures during the same operative session; indicate relative additional procedure complexity.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned (e.g., aborted rib resections).
`53`	Discontinued procedure	Use if the procedure is terminated after anesthesia due to unexpected circumstances and not completed.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons, each reporting their portion of `32906` as applicable by payer policy.
`66`	Surgical team	Use when a surgical team approach is required for complex, prolonged thoracic reconstruction including fistula repair.
`78`	Unplanned return to OR (related procedure)	Use if the patient returns to the OR during the global period for a related procedure such as re-resection or re-repair of a recurrent fistula.
`79`	Unrelated procedure or service during postoperative period	Use if an unrelated procedure is performed during the global period (not in the provided list but a common CMS modifier — not present in the raw list so not included).

Taxonomy Code	Specialty	Notes
340600000X	Thoracic Surgery	Primary specialty performing thoracoplasty and bronchopleural fistula repair.
2080P0201X	General Surgery — Thoracic	General surgeons with thoracic focus who may perform this procedure.
207R00000X	Pulmonary Disease	Involved preoperatively and postoperatively for medical optimization and management of empyema/tuberculosis.
363LP0800X	Infectious Disease	Manages antimicrobial therapy for empyema or tuberculosis-related pleural infection.
2085R0202X	Critical Care Medicine	Manages perioperative critical care for unstable or complex patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J86.0`	Pyothorax with fistula	Represents empyema communicating with bronchial tree; direct indication for pleural space obliteration and fistula closure.
`A15.0`	Tuberculosis of lung	Pulmonary tuberculosis with cavitation can lead to chronic empyema and indications for thoracoplasty.
`J98.4`	Bronchopleural fistula	Directly describes the pathologic communication requiring surgical closure during `32906`.
`J85.1`	Abscess of lung with bronchopleural fistula	Cavitary infection with fistula formation prompting combined rib excision and fistula repair.
`J86.9`	Pyothorax without fistula	Chronic empyema may progress and be managed surgically with thoracoplasty even without documented fistula.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32551`	Tube thoracostomy, includes water-seal drainage; with or without suction	Often performed before `32906` for drainage of empyema and management of pleural air/fluid prior to definitive thoracoplasty.
`32666`	Thoracotomy with decortication of lung	May be performed instead of or in combination with thoracoplasty when removing thickened pleural peel to allow lung re-expansion; may be part of the surgical plan for empyema.
`44120`	Enterolysis (not thoracic) — included here as unrelated	Data not applicable — not used for this thoracic procedure.
`15734`	Muscle, myocutaneous, or fasciocutaneous flap; trunk — for chest wall reconstruction	May be used when a muscle flap (e.g., latissimus dorsi) is required to buttress bronchial repair or obliterate pleural space after rib resection.
`19318`	Reduction mammoplasty (not related)	Not related — included for demonstration only.

CPT 32900: Rib Resection, Partial or Complete

CPT-32905-THORACIC-REPAIR-FOR-EMPYEMA

CPT 32905: Thoracic Repair of Chest Cavity for Empyema

CPT-32940-SURGICAL-PLEUROLYSIS-LYSIS-OF-PLEURAL-ADHESIONS

CPT 32940: Surgical Pleurolysis (Lysis of Pleural Adhesions)

CPT-32960-THERAPEUTIC-PLEURAL-PNEUMOTHORAX-INDUCTION

CPT 32960: Therapeutic Induction of Partial Pneumothorax

Frequently Asked Questions

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for `32906` due to extensive dissection, multiple rib resections, or complex fistula repair.
`23`	Unusual anesthesia	Use if significant, medically necessary anesthesia unrelated to the procedure is required (e.g., procedures performed under general anesthesia when local/regional would normally suffice) — rare for thoracoplasty.
`26`	Professional component	Use if reporting only the physician’s professional component of an associated diagnostic service (e.g., imaging interpretation) when billed separately.
`50`	Bilateral procedure	Use if bilateral thoracoplasty and bilateral bronchopleural fistula closure are performed (uncommon but possible).
`51`	Multiple procedures	Use when `32906` is billed with other unrelated procedures during the same operative session; indicate relative additional procedure complexity.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned (e.g., aborted rib resections).
`53`	Discontinued procedure	Use if the procedure is terminated after anesthesia due to unexpected circumstances and not completed.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons, each reporting their portion of `32906` as applicable by payer policy.
`66`	Surgical team	Use when a surgical team approach is required for complex, prolonged thoracic reconstruction including fistula repair.
`78`	Unplanned return to OR (related procedure)	Use if the patient returns to the OR during the global period for a related procedure such as re-resection or re-repair of a recurrent fistula.
`79`	Unrelated procedure or service during postoperative period	Use if an unrelated procedure is performed during the global period (not in the provided list but a common CMS modifier — not present in the raw list so not included).

Taxonomy Code	Specialty	Notes
340600000X	Thoracic Surgery	Primary specialty performing thoracoplasty and bronchopleural fistula repair.
2080P0201X	General Surgery — Thoracic	General surgeons with thoracic focus who may perform this procedure.
207R00000X	Pulmonary Disease	Involved preoperatively and postoperatively for medical optimization and management of empyema/tuberculosis.
363LP0800X	Infectious Disease	Manages antimicrobial therapy for empyema or tuberculosis-related pleural infection.
2085R0202X	Critical Care Medicine	Manages perioperative critical care for unstable or complex patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J86.0`	Pyothorax with fistula	Represents empyema communicating with bronchial tree; direct indication for pleural space obliteration and fistula closure.
`A15.0`	Tuberculosis of lung	Pulmonary tuberculosis with cavitation can lead to chronic empyema and indications for thoracoplasty.
`J98.4`	Bronchopleural fistula	Directly describes the pathologic communication requiring surgical closure during `32906`.
`J85.1`	Abscess of lung with bronchopleural fistula	Cavitary infection with fistula formation prompting combined rib excision and fistula repair.
`J86.9`	Pyothorax without fistula	Chronic empyema may progress and be managed surgically with thoracoplasty even without documented fistula.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32551`	Tube thoracostomy, includes water-seal drainage; with or without suction	Often performed before `32906` for drainage of empyema and management of pleural air/fluid prior to definitive thoracoplasty.
`32666`	Thoracotomy with decortication of lung	May be performed instead of or in combination with thoracoplasty when removing thickened pleural peel to allow lung re-expansion; may be part of the surgical plan for empyema.
`44120`	Enterolysis (not thoracic) — included here as unrelated	Data not applicable — not used for this thoracic procedure.
`15734`	Muscle, myocutaneous, or fasciocutaneous flap; trunk — for chest wall reconstruction	May be used when a muscle flap (e.g., latissimus dorsi) is required to buttress bronchial repair or obliterate pleural space after rib resection.
`19318`	Reduction mammoplasty (not related)	Not related — included for demonstration only.

CPT 32900: Rib Resection, Partial or Complete

CPT-32905-THORACIC-REPAIR-FOR-EMPYEMA

CPT 32905: Thoracic Repair of Chest Cavity for Empyema

CPT-32940-SURGICAL-PLEUROLYSIS-LYSIS-OF-PLEURAL-ADHESIONS

CPT 32940: Surgical Pleurolysis (Lysis of Pleural Adhesions)

CPT-32960-THERAPEUTIC-PLEURAL-PNEUMOTHORAX-INDUCTION

CPT 32960: Therapeutic Induction of Partial Pneumothorax

Frequently Asked Questions

References

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.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.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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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 32906: Rib Excision with Chest Wall Collapse and Bronchopleural Fistula Closure

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Billing Code Overview

OpenPayer

CPT 32906: Rib Excision with Chest Wall Collapse and Bronchopleural Fistula Closure

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 32906: Rib Excision with Chest Wall Collapse and Bronchopleural Fistula Closure

Sign up for cpt 32906 policy alerts

Billing Code Overview

CPT 32906: Rib Excision with Chest Wall Collapse and Bronchopleural Fistula Closure

Sign up for cpt 32906 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 32906 describe and when is it indicated?

Where is this procedure usually performed?

Which CPT modifiers are commonly applicable to 32906 and when would they be used?

What related CPT codes should be considered in the surgical plan or coding for thoracoplasty with fistula closure?

Which diagnosis codes are associated with appropriate clinical indications for CPT 32906?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 32906 describe and when is it indicated?

Where is this procedure usually performed?

Which CPT modifiers are commonly applicable to 32906 and when would they be used?

What related CPT codes should be considered in the surgical plan or coding for thoracoplasty with fistula closure?

Which diagnosis codes are associated with appropriate clinical indications for CPT 32906?

References