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.

How the No Surprises Act Has Impacted Providers and Physician Billing Services
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How the No Surprises Act Has Impacted Providers and Physician Billing Services

The No Surprises Act (NSA) brought with it large amounts of speculation on its impact on physician billing services, and now, in 2024, it’s been in play long enough to finally understand how it’s affecting providers and how they’re responding. 

Two years in, the industry is seeing results that anyone responsible for physician coding and billing services should consider – and information they should evaluate as they consider their relationship with physician billing companies as a potential solution. 

Looking Back at the No Surprises Act

The No Surprises Act went into effect on January 1, 2022, shaking up physician billing services around the country. It was intended to address “surprise medical bills” – the issue of insured consumers receiving care with an out-of-network provider they didn’t choose. They’re then shouldered with a bill they weren’t expecting and didn’t authorize. This issue happens in 20% of emergency department visits and around 9-16% of in-network hospitalizations in relation to services from providers like an anesthesiologist. Since the bill took effect, there have been developments around the arbitration process, dispute resolution, and the impact on patients. 

When the act first took hold, the American Medical Association stepped in to help physicians understand their rights when caring for patients who obtained out-of-network services without their knowledge [1]. It put together a toolkit that focused on three operational challenges that physicians would need to address. 

  • Notice-and-consent requirements which physicians are now required to make publicly available for all patients enrolled in commercial health coverage
  • Rules around emergency services and post-stabilization for hospitals
  • Their obligation to provide good faith estimates for their uninsured and self-pay patients 

Impact of the No Surprises Act on Physicians

While consumers have generally celebrated the outcomes of the NSA, many are realizing that providers are now experiencing financial hardships and other burdens. Out of all providers, physicians’ groups and air medical transportation companies have shouldered much of the burden in their work to provide emergency services. This is reflected in the fact that bankruptcies in healthcare jumped 84% between 2021 and 2022, with many in the industry directly blaming the NSA along with other factors like payer contracts and higher costs of debts [2]. By November 2023, 30 public companies had pointed to the NSA as a risk to their financial performance [3]. 

Today, providers are open about emerging issues that are affecting them and their efforts in physician coding.

Claims Are Backlogged

One of the downstream effects of the NSA is the impact of the dispute and settlement process. When the law was created, it included requirements to address negotiations and settlements between providers and payers to handle services rendered outside contractual agreements. This falls under the “open negotiation” process, meaning that if the parties don’t come to an agreement within 30 business days of open negotiation, the decision then falls to the Independent Dispute Resolution (IDR) process which involves submission to an independent third party. The case can vary depending on the insurance plan type, sometimes following federal rules and sometimes falling under a process determined by the state. 

The result has been increased complexity and slower processing in the healthcare revenue cycle. The U.S. Government Accountability Office (GAO) reports that while federal departments expected around 22,000 disputes through the IDR process in 2022, over 490,000 were submitted between April 2022 and June 2023. As of June 2023, a full 61% of the disputes were unresolved [4]. 

Increased Resource Use of Physician Billing Services

Of course, these new requirements don’t exist in a vacuum. Physicians have had to employ additional resources to meet the requirements of the act. Providers are required to inform every patient about protections against balance billing and have an obligation to provide good faith estimates for their uninsured and self-pay patients. 

All this is happening in the midst of a healthcare revenue cycle staffing shortage that is affecting physician coding and billing across the board. According to Becker’s Hospital Review, 32% of revenue cycle leaders report challenges with hiring and training staff in 2024 [5]. This issue directly impacts provider revenue cycle outcomes, since shortages contribute to already growing denial rates. 

Processes That Are More Complex

Complexity is an ongoing concern in physician medical billing. Offices face falling reimbursement rates, shifting payer relationships, and increasing costs. In addition, many are inundated with pressures to use data to make increasingly productive decisions. The NSA only increased many of these demands. 

Leaders in charge of physician billing services have to adapt their revenue cycle to document and address low payments from payers they’re not contracted with. They also have to augment their staff with professionals who understand physician billing services and have the physician revenue cycle management and contract management skills that align with NSA processes. 

In response to pressures from legislation like the NSA, many healthcare leaders are looking into the support of physician billing companies. These partners can help improve revenue cycle results, increase efficiency, and manage the future impact of the act. To explore some of your options, contact us today. 

 

References
[1] A. Robeznieks, “The No Surprises Act is in effect. What physicians need to know.,” American Medical Association, 14 January 2022. Available: https://www.ama-assn.org/health-care-advocacy/access-care/no-surprises-act-effect-what-physicians-need-know.
[2] F. J. Thomas, “84% Increase of Healthcare Bankruptcies Due to No Surprises Act,” WorkersCompensation.com, LLC, 8 October 2023. Available: https://www.workerscompensation.com/daily-headlines/84-increase-of-healthcare-bankruptcies-due-to-no-surprises-act/.
[3] S. Biswas and B. Yerak, “Surprise Medical Billing Law Heaps Pressure on Healthcare Providers,” Dow Jones & Company, Inc, 28 November 2023. Available: https://www.wsj.com/articles/surprise-medical-billing-law-heaps-pressure-on-healthcare-providers-f9583485.
[4] U.S. Government Accountability Office, “Roll out of Independent Dispute Resolution Process for Out-Of-Network Claims Has Been Challenging,” 12 December 2023. Available: https://www.gao.gov/products/gao-24-106335.
[5] A. Cass, “The biggest challenges facing revenue cycle departments in 2024,” Beckers Hospital Review, 24 January 2024. Available: https://www.beckershospitalreview.com/finance/the-biggest-challenges-facing-revenue-cycle-departments-in-2024.html.

Accounts Receivable Management Tips for Healthcare: It’s Time to Standardize Your Metrics for Denial Management
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Accounts Receivable Management Tips for Healthcare: It’s Time to Standardize Your Metrics for Denial Management

Claim denial rates are still a major concern for accounts receivable management in 2022. For example, denial rates for marketplace payers have reached rates as high as 80% according to the Kaiser Family Foundation [1]. But this is only the beginning. COVID has put upward pressure on denial rates for a while now. All of this means that revenue cycle leaders should be taking a fresh look at their denial management practices, not only considering accounts receivable management services but also seeing this as an opportunity to investigate new and more effective approaches to denial management.

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