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:
- Rationale for new FPB codes
- How to best apply the new FPB codes for lower extremity and thoracic regions
- 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.
