Navigating CPT Codes for Thoracic and Lower Extremity Fascial Plane Block Procedures

Introduction:

Fascial plane blocks are an advanced regional anesthesia technique designed to provide effective pain relief by injecting local anesthetic into specific tissue planes. Unlike traditional nerve blocks that target individual nerves, fascial plane blocks work by bathing multiple nerves within a fascial compartment, leading to widespread analgesia with minimal complications. These procedures have gained popularity in both surgical and non-surgical settings due to their ability to improve pain control while reducing the need for opioids.

‍Fascial Plane Blocks: 

Thoracic and Trunk Blocks 

Commonly used for rib fractures, breast surgeries, and thoracic procedures.

• Erector Spinae Plane (ESP) Block – Provides pain relief for thoracic, abdominal, and lumbar surgeries.

• Pectoral Nerve Blocks (PECS I & II) – Used for breast surgeries by anesthetizing the pectoral region and axilla.

• Serratus Anterior Plane Block (SAPB) – Effective for rib fractures and thoracic procedures by numbing the lateral chest wall. 

Lower Extremity Blocks

Primarily used for hip, knee, and lower limb surgeries.

• Adductor Canal Block (ACB) – Provides analgesia for knee surgeries while preserving motor function.

• Fascia Iliaca Block (FIB) – Used for hip fractures and lower extremity procedures.

Billing & Coding Guidelines:

• The American Medical Association (AMA) has designated specific Current Procedural Terminology (CPT) codes for these procedures, effective January 1, 2025.

• These new thoracic and lower extremity fascial plane block services expand on the  existing transversus abdominis plane (TAP) block code family in CPT (64486 – 64489).

Thoracic Fascial Plane Blocks

Lower Extremity Fascial Plane Block

Key Enhancements in the CPT 2025 Code Sets:

Prior to 2025, thoracic and lower extremity FPBs were reported using the unlisted procedure code (64999) due to the absence of dedicated CPT codes. The newly introduced codes (64466-64469, 64473, 64474) now provide specific reporting options for FPBs involving:

• Thoracic fascial plane blocks (unilateral/bilateral).

• Lower extremity fascial plane blocks (unilateral).

• Administration by single injection or continuous infusion.

Do not report Imaging Guidance separately

• These nerve block procedure codes include imaging guidance. 

• Hence, the following imaging guidance codes - 76942, 77001, 77002, 77012, or 77021 should not be reported with these nerve blocks.

Reimbursement Guidelines:

MPFS Guidelines

2025 National Physician Fee Schedule Relative Value File - January Release.

• Status Indicator: A (Active code). These codes are separately paid under the physician fee schedule if covered. A/B MACs (B) remain responsible for coverage decisions in the absence of a national Medicare policy. 

• Global Days: “0” (same-day global period - 000). This means that all related preoperative and postoperative services are included in the payment for the day of the procedure only. Evaluation and management services on the procedure day are generally not payable.

• Multiple Procedure (Modifier 51): All primary codes for harvest, preparation, and application have a "2" indicator, meaning standard multiple procedure payment adjustment rules apply. A 50% payment reduction applies when these procedures are performed with other procedures in the same operative session.

• Bilateral Surgery (Modifier 50): The code descriptor states that the procedure may be performed either unilaterally or bilaterally.

• Assistant at Surgery (Modifiers 80, 81, 82, AS): Statutory payment restrictions apply. An assistant at surgery may not be paid.

• Co-surgeons (Modifier 62): Not permitted for these procedures.

• Team Surgery (Modifier 66): Not permitted for these procedures.

‍OCE Guidelines

• In outpatient settings, these services are not paid separately; these are packaged into other major services.

‍Ambulatory Surgery Centers

• N1-Packaged service/item; no separate payment made.

Conclusion:

• With dedicated CPT codes (64466, 64467, 64468, 64469), healthcare providers can now accurately bill for performing thoracic fascial plane blocks, which was previously more challenging due to the lack of specific codes. 

• This procedure can provide targeted pain relief in the chest area, potentially reducing the need for high doses of opioids post-surgery or during treatment.

• Clearer coding guidelines may encourage more widespread adoption of this technique by pain management specialists.

• Healthcare providers who perform these blocks will be able to receive appropriate reimbursement for their services.

References:

• AMA CPT Manual 2025
• CMS MPFS
• CMS ASC Payment Rates Addenda
• I/OCE Quarterly Release Files
• American Society of Anesthesiologists
• Journal of Anesthesia, Analgesia and Critical Care

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