Look to the New Plane Block Code for 2025
Discover the new 2025 CPT® codes for thoracic fascial pain blocks, improving postoperative recovery by targeting pain and reducing opioid use during orthopedic procedures.
Orthopedic Billing And Coding Guidelines
Enhancing Postoperative Recovery with Updated CPT® Codes 2025
The American Medical Association (AMA) has announced the release of new, revised, and deleted codes for 2025. Among the updates, a new code set has been introduced for a specific block that your surgeon may use during orthopedic procedures.
New CPT® Codes for Thoracic Fascial Pain Blocks
Starting January 1, 2025, CPT® will introduce new codes dedicated to thoracic fascial pain blocks. This type of regional anesthesia is commonly used to manage thoracic pain, especially during rib and thoracic surgeries. The procedure involves injecting a local anesthetic into the fascial planes within the chest area, effectively blocking pain signals.
Benefits: These blocks offer significant advantages, including reducing the need for postoperative opioid use and promoting a faster recovery. By targeting pain more precisely, thoracic fascial pain blocks can improve overall patient outcomes.
The following CPT® codes will be used for thoracic fascial plane blocks:
- 64466: Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed
- 64467: … by continuous infusion(s), including imaging guidance, when performed
- 64468: Thoracic fascial plane block, bilateral; by injection(s), including imaging guidance, when performed
- 64469: … by continuous infusion(s), including imaging guidance, when performed
- 64473: Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed
- 64474: … by continuous infusion(s), including imaging guidance, when performed
CPT® has placed restrictions on reporting these codes in combination with the following:
- 76942: Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), including imaging supervision and interpretation
- +77001: Fluoroscopic guidance for central venous access device placement, replacement, or removal, including related contrast injections and venography
- +77002: Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)
- 77012: Computed tomography guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), including radiological supervision and interpretation
- 77021: Magnetic resonance imaging guidance for needle placement (e.g., biopsy, needle aspiration, injection, localization device), including radiological supervision and interpretation
Example: Applying New CPT® Codes for Fascial Plane Block
Here’s a clinical scenario demonstrating how the new fascial plane block codes might be used:
A 65-year-old patient is admitted to the hospital following a motor vehicle accident where they were a passenger in a car that collided with an SUV. The patient reports severe pain in the left chest and trunk, with difficulty breathing due to the pain. A four-view chest X-ray confirms two left-sided rib fractures. The surgeon decides to perform a unilateral fascial plane block via continuous infusion.
The procedure involves positioning the patient supine, using ultrasound guidance to visualize the affected area. The surgeon then inserts the needle into the fascial plane and injects 20 mL of 0.25% bupivacaine.
For this encounter, the following codes would be reported:
- 64467 for the fascial plane block
- 71048 (Radiologic examination, chest; 4 or more views) for the X-ray
- Modifier 26 appended to 71048 to indicate the surgeon’s professional component, excluding equipment charges
- S22.42XA (Multiple fractures of ribs, left side, initial encounter for closed fracture)
- V43.61XA (Car passenger injured in collision with sport utility vehicle in traffic accident, initial encounter)
Note on X-ray Coding: While the example above includes the X-ray code, the surgeon may not always be reimbursed for interpreting the X-ray. Whether the surgeon can bill for the interpretation depends on the facility’s protocol and whether a radiologist is responsible for the official reading.
CPT® Code Resequencing for 2025
The new fascial plane block codes are part of a group of resequenced codes in CPT® 2025. They are not listed in their numerical order but instead follow code +64484 (Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance) and precede 64486 (Transversus abdominis plane (TAP) block).
The resequenced codes will appear as follows in the 2025 CPT® book:
- 64461 (Paravertebral block (PVB), thoracic; single injection site, with imaging guidance, when performed)
- +64462 (Second and additional injection sites, with imaging guidance, when performed)
- 64463 (Continuous infusion by catheter, with imaging guidance, when performed)
- 64466
- 64467
- 64468
- 64469
- 64473
- 64474
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