2025 CPT Code Updates for Anesthesia Billing- Fascial Plane Blocks, Modifiers & More Image
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2025 CPT Code Updates for Anesthesia Billing: Fascial Plane Blocks, Modifiers & More

Anesthesia billing is increasing in complexity, and healthcare revenue cycle leaders should be ready to make adjustments to their billing, training, and compliance strategies. 

The anesthesia revenue cycle has received recent updates, so we’ve summarized those in the context of anesthesia billing as a whole. This article will walk you through updates to fascial plane block CPT codes as well as training options for your leadership and staff who want to stay on top of changes to anesthesia billing services. 

The Basics of Anesthesia Billing

Anesthesia revenue cycle management is uniquely complex [1]. Unlike standard medical billing, it works from a precise formula – base units + time units × conversion factor. 

Each anesthesia CPT code corresponds to a surgical procedure family and carries predetermined base units. Time units, which are calculated by anesthesia duration, vary by payer. Medicare calculates to one decimal (e.g., 129 minutes = 8.6 units), while some commercial payers round up (e.g., 9 units). For example, a total knee arthroplasty (CPT code 27447) crosswalks to anesthesia code 01402 (7 base units). With 129 minutes of anesthesia time, Medicare bills 15.6 units (7 + 8.6), while a commercial payer might bill 16 units (7 + 9). The result is a measurable financial impact. Medicare’s 2022 conversion factor ($21.5623) translates to $336.37, whereas a median commercial factor ($78.00) generates $1,216.80.

Staffing modifiers also complicate reimbursement. Medicare requires that payment be allocated between anesthesiologists and CRNAs. This split breaks down differently depending on the modifier, for example:

  • Personally performed (AA): 100% to physician
  • Medical direction of nonphysician anesthetist (QK/QY or QX): 50/50 split
  • CRNA service without medical direction (QZ): 100% to nonphysician

Commercial payers often do not follow modifiers, instead paying a single clinician. This misapplication increases the risk of underpayment or denials – making anesthesia billing services a critical investment.

Additionally, separately billable procedures (e.g., arterial lines, nerve blocks) should not be bundled into anesthesia payments. Payer contracts should explicitly exclude this type of bundling. For example, a post-operative femoral nerve block (CPT code 64447) should be billed separately. Working with an experienced anesthesia billing company improves the chances that this type of nuance is reflected in your payer contracting.

2025 CPT Code Updates for Anesthesia Billing

The American Society of Anesthesiologists (ASA) has successfully advocated for the creation of new fascial plane block CPT codes [2]. These take effect in January 2025. We encourage you to review the original announcement from the ASA for details and accuracy. 

The updates reflect the growing adoption of ultrasound-guided regional anesthesia techniques. They also aim to support proper reimbursement for anesthesiologists providing advanced pain management services. The changes establish dedicated codes for thoracic and lower extremity fascial plane blocks while clarifying the application of existing abdominal block codes.

Thoracic Fascial Plane Blocks (64466–64469)
In an effort to move away from the frequent use of unlisted CPT code 64999, the 2025 updates have introduced four dedicated codes for thoracic fascial plane blocks. These procedures, which previously lacked specific coding guidance, now have clearer pathways for billing and documentation. These address procedures including:

  • Erector spinae plane (ESP) blocks
  • Serratus anterior plane blocks
  • Parasternal intercostal blocks
  • Pectoserratus (PECS) blocks

These codes distinguish between single-injection (CPT code 64466 and CPT code 64468) and continuous infusion (CPT code 64467 and CPT code 64469) techniques, with imaging guidance included when performed. The codes apply only when the injection site is within the thoracic fascial plane. ESP blocks administered in the lumbar region, for example, should still be reported with the unlisted code 64999, since a dedicated lumbar code does not exist.

Lower Extremity Fascial Plane Blocks (64473–64474)
For lower extremity pain management, two new codes cover:

  • Fascia iliaca blocks
  • PENG (pericapsular nerve group) blocks
  • IPACK (infiltration between the popliteal artery and knee capsule) blocks

CPT code 64473 applies to single-injection blocks, while CPT code 64474 covers continuous infusions. Both include imaging guidance. Bilateral procedures require modifier -50 or separate line-item billing, depending on payer preferences.

Clarifications to Abdominal Fascial Plane Blocks (64486–64489)
While the descriptors for existing abdominal codes remain unchanged, the 2025 CPT manual now explicitly outlines that codes 64486–64489 encompass all abdominal fascial plane blocks, including:

  • Transversus abdominis plane (TAP) blocks
  • Rectus sheath blocks
  • Quadratus lumborum blocks
  • External oblique intercostal blocks

Financial Impact and RVU Values
The new codes introduced in the 2025 CPT updates carry varying RVUs. Continuous infusion blocks are generally reimbursed at higher rates (e.g., 1.74 RVUs for CPT code 64467 vs. 1.50 for CPT code 64466). 

These values are based on the 2025 Medicare Physician Fee Schedule and may vary slightly by geographic region due to GPCI adjustments.

Proper utilization of these codes, particularly for continuous catheters, can significantly enhance revenue for practices offering advanced regional anesthesia services.

Training: Bridging Knowledge Gaps for Optimal Billing

The American Society of Anesthesiologists (ASA) is offering a 1.0 CME/CEU webinar to master these changes [3]. Designed for coders, pain physicians, and revenue cycle leaders, it covers:

  1. Rationale for new FPB codes
  2. How to best apply the new FPB codes for lower extremity and thoracic regions
  3. Documentation, compliance, and anesthesia billing best practices

Outsourcing Anesthesia Billing

Outsourcing anesthesia billing requires careful evaluation to make sure your revenue cycle remains both efficient and compliant. Look for a vendor who demonstrates deep specialization in anesthesia revenue cycle management, not just general medical billing expertise. Prioritize partners who demonstrate that they stay current with evolving requirements, such as the 2025 fascial plane block codes.

At 3Gen Consulting, we offer end-to-end anesthesia billing services tailored to meet the demands of today’s evolving RCM landscape. Providers across the U.S. turn to our anesthesia medical billing experts to improve accuracy, reduce denials, and capture every dollar earned. Whether you’re optimizing financial performance or looking for a partner who can ensure compliance, we’re here to help.

References

[1] American Society of Anesthesiologists, “Anesthesia Payment Basics Series: #3 Payment, Conversion Factors, Modifiers,” December 2022. Available: https://www.asahq.org/quality-and-practice-management/managing-your-practice/timely-topics-in-payment-and-practice-management/anesthesia-payment-basics-series-3-payment-conversion-factors-modifiers.
[2] American Society of Anesthesiologists, “New and Updated Fascial Plane Block CPT Codes,” 23 June 2025. Available: https://www.asahq.org/quality-and-practice-management/managing-your-practice/timely-topics-in-payment-and-practice-management/2025-updated-fascial-plane-block-cpt-codes.
[3] American Society of Anesthesiologists, “Training on the New Fascial Plane Block CPT Codes,” 1 January 2025. Available: e024fc00w00.

The No Surprises Act Is in Jeopardy, But Providers Should Stay the Course Image
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The No Surprises Act Is in Jeopardy, But Providers Should Stay the Course

Recent federal layoffs have added a new layer of uncertainty for providers impacted by the No Surprises Act. 

The federal office responsible for implementing this critical legislation faces staffing cuts, so revenue cycle leaders must stay proactive to mitigate the impact of surprise billing on their organizations. While the future of surprise billing legislation may be in limbo, providers can take actionable steps to strengthen their revenue cycle operations, including leveraging medical billing services and partnering with the best medical billing company in the USA to support compliance

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HCC Risk Adjustment Coding Update for 2025
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HCC Risk Adjustment Coding Update for 2025

Value-based reimbursement is driving expanded complexity in the healthcare industry, increasing the need for revenue cycle leaders to ensure patient conditions are captured accurately. One of the primary ways to do this is through hierarchical condition category (HCC) risk adjustment coding. 

To help you keep your HCC risk adjustment coding up with the challenges of 2025, 3Gen Consulting has put together this update of the latest research and findings in HCC risk adjustment.  

Why Research in HCC Risk Adjustment Coding Matters

One of the primary reasons that research in HCC risk adjustment coding is so important is that differences in calculations can shift incentives for different healthcare stakeholders. These codes are based on the complexity of a patient’s health condition, so coding can make a significant difference in reimbursement received. 

For example, highly complex patients will often receive higher reimbursement, so accurate coding of a patient’s chronic condition can increase their risk score, resulting in higher reimbursement. This is considered acceptable since the provider is assumed to be expending more time and resources managing more complex patients that require greater care. 

While this dynamic can be used for unethical purposes, not all coding differences are used illegally. Sometimes, there is an issue of coding simply being applied differently between Medicare and Medicare Advantage (MA) programs, which should ideally be similar in coding practices and reimbursement. This is of particular concern to government agencies since Medicare Advantage is growing at a significant rate. The Congressional Budget Office (CBO) has projected that the share of beneficiaries of Medicare Advantage will increase from 54% of eligible Medicare beneficiaries in 2024 to around 64% 10 years from now. Today, it is believed that Medicare Advantage plans are significantly overpaid in comparison to traditional Medicare plans. The Medicare Payment Advisory Commission (MedPAC) has estimated that, in 2024, MA payments were 22% higher than traditional Medicare, a difference of $83 billion [1]. These overpayments tend to benefit plans rather than beneficiaries, meaning that there is a financial incentive for plans to restrict care after members are enrolled, something that can result in delays and denials of service and ultimately, poorer outcomes for patients. 

Medicare Advantage Risk Adjustment Can Be Strengthened with Diagnosis Codes and Survey Responses

As things stand now under the existing Medicare Advantage risk-adjustment system, participating plans face questionable incentives. These include incentives to report diagnosis codes on their enrollee medical claims that reflect more severe health conditions and additional conditions. This action increases enrollee risk scores and payments. With the goal of improving risk adjustment integrity, some researchers have released a proposal including four alternative methods for constructing risk scores [2]: 

  • Calculating Hierarchical Condition Categories scores while excluding diagnosis codes from health risk assessments and chart reviews
  • Calculating HCC risk adjustment coding scores excluding diagnosis codes most subject to score inflation
  • Using pharmaceutical claims only 
  • Using self-reported survey responses alone or potentially in conjunction with diagnosis codes

They compared the predictive accuracy of each of these strategies against the standard HCC risk adjustment coding approach. The researchers did this using 2016–19 medical and pharmaceutical claims linked to Consumer Assessment of Healthcare Providers and Systems survey responses gathered from 151,432 Medicare Advantage enrollees. They found that, in relation to the standard HCC risk adjustment model, the models that combined survey responses with risk scores did a better job of predicting healthcare use. This approach explained 5.8-6.0 percent of the individual variation in total price-standardized Medicare Advantage utilization in comparison to 5.1%. The findings suggest that diagnosis codes can be used in conjunction with survey responses to improve Medicare Advantage risk adjustment results. 

Lack of Persistent Medicare Coding May Widen Risk-Score Gaps

Research from HealthAffairs has revealed that risk-score gaps could be attributable to differences in capture of diagnostic codes [3]. 

Medicare Advantage payments are adjusted using a risk-score model calibrated on demographic data and diagnostic data from traditional Medicare beneficiaries. This data is in turn applied to Medicare Advantage beneficiaries. If Medicare Advantage plans are capturing more diagnostic codes in comparison to traditional Medicare, they can receive higher payments in comparison. 

Researchers analyzed Medicare Advantage encounter data and Medicare claims from 2017-2019 to compare persistence of diagnostic coding under sixteen chronic conditions. Analysis found that the difference accounted for 2.85 percentage points (22.3%) of the Medicare/MA risk-score gap in 2020, amounting to $8.1 billion in Medicare spending. 

Work with 3Gen Consulting

As the complexity of HCC risk adjustment scoring increases and the need for certified risk adjustment coders grows, 3Gen Consulting is here to help support your revenue cycle needs. Schedule a call today to discuss how we can improve the efficiency and effectiveness of your risk adjustment efforts.

References

[1] P. N. Van de Water, “Growth in Medicare Advantage Raises Concerns,” Center on Budget and Policy Priorities, 10 January 2025. Available: https://www.cbpp.org/research/health/growth-in-medicare-advantage-raises-concerns.
[2] M. Bellerose, H. O. James, J. Shroff, A. M. Ryan and D. J. Meyers, “Combining Patient Survey Data With Diagnosis Codes Improved Medicare Advantage Risk-Adjustment Accuracy,” Health Affairs, vol. 44, no. 1, 2025.
[3] N. Ghoshal-Datta, M. E. Chernew and J. M. McWilliams, “Lack Of Persistent Coding In Traditional Medicare May Widen The Risk-Score Gap With Medicare Advantage,” Health Affairs, vol. 43, no. 12, 2024.

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