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ASA Monitor Article on Fascial Plane Blocks
ASA Webinar on Fascial Plane Blocks
After significant effort by ASA physician volunteers and ASA staff, there are now new fascial plane block CPT codes that have been valued and included in the Medicare physician fee schedule so anesthesiologists can appropriately bill for their work to improve the pain management of patients through these procedures. This Timely Topic article will briefly cover the new thoracic and lower extremity fascial plane block CPT codes released in January 2025 and important updates to existing CPT codes 64486–64489.
The integration of ultrasound guidance into the practice of regional anesthesia and analgesia has resulted in the rapid development and adoption of fascial plane block techniques1. Fascial plane blocks involve the deposition of local anesthetic solution into layers or compartments that spread to terminal nerves, and evidence supports their use as part of a multimodal analgesic regimen for perioperative and other acute pain management2. Since these procedures differ from traditional nerve and plexus blocks, new Current Procedural Terminology (CPT) codes were required.
A number of fascial plane blocks for thoracic surgery and chest wall trauma have been described in the literature [1,3]. Some examples include: erector spinae plane (ESP) block; serratus anterior plane block; parasternal intercostal block; and interpectoral plane and pectoserratus plane blocks (also known as ‘PECS’ block)1. The new CPT codes 64466–64489 apply to single-injection or continuous thoracic fascial plane blocks, either performed unilaterally or bilaterally, and are appropriate when the site of injection is a thoracic fascial plane (Table 1). Imaging is included in these codes, when performed. These codes are not appropriate for an ESP block performed in the lumbar region; since there is no specific lumbar ESP block code, 64999 should be used.
Fascial plane block techniques for pain management after lower limb surgery or trauma may include: fascia iliaca block; pericapsular nerve group (PENG) block; or infiltration between the popliteal artery and capsule of the knee (IPACK) block4. The new CPT codes 64473 and 64474 may be used for single-injection and continuous lower extremity fascial plane blocks, respectively (Table 1). Imaging is included in these codes, when performed, and modifier -50 may be used when procedures are performed bilaterally.
Although the code descriptors for existing CPT codes 64486–64489 have not changed, the January 2025 edition of CPT Professional has updated the section subheading for “Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic – Somatic Nerves” to now read: “Codes 64486, 64487, 64488, 64489 describe injection of an abdominal fascial plane block”5. In addition to the transversus abdominis plane (TAP) block and rectus sheath block, which had been previously specified in the code descriptor, newer abdominal fascial plane blocks such as quadratus lumborum block and external oblique intercostal block are appropriate for these CPT codes as long as the site of injection is an abdominal fascial plane (Table 2).
Table 1. Fascial plane block Current Procedural Terminology codes and relative value units.
| CPT Code | Code Descriptor | RVUs |
| 64466 | Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed | 1.50 |
| 64467 | by continuous infusion(s), including imaging guidance, when performed | 1.74 |
| 64468 | by continuous infusion(s), including imaging guidance, when performed | 1.67 |
| 64469 | by continuous infusion(s), including imaging guidance, when performed | 1.83 |
| 64473 | Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed | 1.34 |
| 64474 | by continuous infusion(s), including imaging guidance, when performed | 1.67 |
| 64486 | Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)* | 1.20 |
| 64487 | by continuous infusion(s) (includes imaging guidance, when performed)* | 1.39 |
| 64488 | Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)* | 1.40 |
| 64489 | by continuous infusions (includes imaging guidance, when performed)* | 1.75 |
*Codes 64486, 64487, 64488, and 64489 apply to performance of an abdominal fascial plane block, which includes quadratus lumborum block and external oblique intercostal plane block.
Table 2. Fascial plane block Current Procedural Terminology codes categorized by region and technical performance.
| Region | Unilateral | Bilateral |
| Injection(s) | Continuous Infusion | Injection(s) | Continuous Infusion | |
| Thoracic | 64466 | 64467 | 64468 | 64469 |
| Abdominal | 64486 | 64487 | 64488 | 64489 |
| Lower Extremity | 64473 | 64474 | n/a | n/a |
Curated by: The ASA Committee on Economics
Date of last update: June 23, 2025
