CPT code 64468: Thoracic block, bilateral injection2026 Medicare rate & RVUs in Puerto Rico
Reports bilateral injection of anesthetic into thoracic fascial planes for chest-wall analgesia, commonly around breast or other thoracic surgery.
In Puerto Rico, Medicare pays $165.41 for 64468 in the office and $68.16 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 64468 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 64468 covers
This code covers injection of anesthetic into thoracic fascial planes on both sides for regional analgesia. Anesthesiologists and acute-pain specialists commonly perform the block around breast or other thoracic surgery to manage chest-wall pain. It describes injections, not delivery through a catheter for continuous infusion; imaging guidance, when performed, is included in the block service.
Report one unit for the bilateral block, with documentation identifying the sites and both sides treated, the anesthetic injected, and the clinical purpose. The 0-day global period includes same-day preoperative and postoperative care. When this block is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. The code is priced as bilateral, so modifier 50 does not increase payment. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Puerto Rico compares for 64468
Across 109 of 109 payment localities, the office rate for 64468 runs from $147.11 in Arkansas to $214.35 in San Benito County, CA. Puerto Rico pays $165.41. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$165.41
- Los Angeles, CA · California$184.07+$18.66
- Washington, DC area · District of Columbia$186.51+$21.10
- Miami, FL · Florida$176.29+$10.88
- Chicago, IL · Illinois$171.73+$6.32
- Manhattan, NY · New York$187.74+$22.33
- Alaska · Alaska$196.12+$30.71
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $149.05 | $64.88 |
| ArkansasArkansas | $147.11 | $64.48 |
| ArizonaArizona | $160.36 | $67.15 |
| Bakersfield, CACalifornia | $173.48 | $68.05 |
| Chico, CACalifornia | $173.00 | $67.57 |
| El Centro, CACalifornia | $173.03 | $67.60 |
| Fresno, CACalifornia | $173.00 | $67.57 |
| Hanford, CACalifornia | $173.00 | $67.57 |
| Madera, CACalifornia | $173.00 | $67.57 |
| Merced, CACalifornia | $173.00 | $67.57 |
| Modesto, CACalifornia | $173.00 | $67.57 |
| Napa, CACalifornia | $198.65 | $71.86 |
| Oxnard, CACalifornia | $183.06 | $69.35 |
| Redding, CACalifornia | $173.00 | $67.57 |
| Rest of CaliforniaCalifornia | $173.00 | $67.57 |
| Riverside, CACalifornia | $174.64 | $69.22 |
| Sacramento, CACalifornia | $181.06 | $69.19 |
| Salinas, CACalifornia | $180.37 | $68.88 |
| San Diego, CACalifornia | $184.23 | $69.18 |
| Marin County, CACalifornia | $209.79 | $74.16 |
| San Francisco, CACalifornia | $209.62 | $73.99 |
| San Benito County, CACalifornia | $214.35 | $75.64 |
| Santa Clara County, CACalifornia | $213.66 | $74.94 |
| San Luis Obispo, CACalifornia | $177.51 | $67.95 |
| Santa Cruz, CACalifornia | $185.70 | $68.82 |
| Santa Maria, CACalifornia | $180.94 | $68.78 |
| Santa Rosa, CACalifornia | $187.55 | $69.43 |
| Stockton, CACalifornia | $173.00 | $67.57 |
| Vallejo, CACalifornia | $198.40 | $71.62 |
| Visalia, CACalifornia | $173.00 | $67.57 |
| Yuba City, CACalifornia | $173.00 | $67.57 |
| ColoradoColorado | $170.60 | $68.25 |
| ConnecticutConnecticut | $174.55 | $70.95 |
| DelawareDelaware | $162.84 | $67.80 |
| Fort Lauderdale, FLFlorida | $169.74 | $72.30 |
| Rest of FloridaFlorida | $162.24 | $70.28 |
| Atlanta, GAGeorgia | $167.18 | $69.45 |
| Rest of GeorgiaGeorgia | $153.97 | $68.16 |
| Hawaii, Guam, HIHawaii | $176.59 | $67.22 |
| IowaIowa | $152.40 | $64.38 |
| IdahoIdaho | $153.30 | $64.80 |
| East St. Louis, ILIllinois | $161.02 | $72.52 |
| Rest of IllinoisIllinois | $158.03 | $70.20 |
| Suburban Chicago, ILIllinois | $171.41 | $72.62 |
| IndianaIndiana | $154.10 | $64.93 |
| KansasKansas | $151.78 | $64.82 |
| KentuckyKentucky | $152.27 | $66.75 |
| New Orleans, LALouisiana | $158.83 | $68.31 |
| Rest of LouisianaLouisiana | $152.06 | $66.93 |
| Metropolitan Boston, MAMassachusetts | $186.36 | $71.50 |
| Rest of MassachusettsMassachusetts | $169.75 | $68.45 |
| Baltimore area, MDMaryland | $174.05 | $70.83 |
| Rest of MarylandMaryland | $165.72 | $68.38 |
| Rest of MaineMaine | $154.05 | $65.55 |
| Southern Maine, MEMaine | $161.54 | $66.21 |
| Detroit, MIMichigan | $164.10 | $71.27 |
| Rest of MichiganMichigan | $155.85 | $68.03 |
| MinnesotaMinnesota | $163.85 | $64.86 |
| Metropolitan Kansas City, MOMissouri | $157.82 | $67.49 |
| Metropolitan St. Louis, MOMissouri | $159.31 | $67.73 |
| Rest of MissouriMissouri | $149.73 | $66.81 |
| MississippiMississippi | $148.45 | $65.62 |
| MontanaMontana | $164.32 | $68.13 |
| North CarolinaNorth Carolina | $155.50 | $65.75 |
| North DakotaNorth Dakota | $161.36 | $65.16 |
| NebraskaNebraska | $153.14 | $64.35 |
| New HampshireNew Hampshire | $168.01 | $67.87 |
| Northern New JerseyNew Jersey | $184.88 | $73.30 |
| Rest of New JerseyNew Jersey | $176.65 | $71.60 |
| New MexicoNew Mexico | $156.63 | $68.42 |
| NevadaNevada | $163.60 | $67.31 |
| NYC suburbs and Long Island, NYNew York | $191.93 | $77.56 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $177.80 | $72.46 |
| Queens, NYNew York | $189.12 | $75.42 |
| Rest of New YorkNew York | $157.60 | $66.22 |
| OhioOhio | $155.25 | $67.42 |
| OklahomaOklahoma | $151.99 | $66.09 |
| Portland, OROregon | $175.56 | $68.69 |
| Rest of OregonOregon | $162.42 | $66.62 |
| Metropolitan Philadelphia, PAPennsylvania | $170.58 | $70.44 |
| Rest of PennsylvaniaPennsylvania | $155.46 | $67.15 |
| Rhode IslandRhode Island | $168.29 | $68.92 |
| South CarolinaSouth Carolina | $155.61 | $66.73 |
| South DakotaSouth Dakota | $161.01 | $64.81 |
| TennesseeTennessee | $152.47 | $65.03 |
| Austin, TXTexas | $169.95 | $68.18 |
| Beaumont, TXTexas | $154.54 | $67.00 |
| Brazoria, TXTexas | $162.72 | $67.39 |
| Dallas, TXTexas | $163.69 | $67.88 |
| Fort Worth, TXTexas | $162.71 | $67.86 |
| Galveston, TXTexas | $163.17 | $67.65 |
| Houston, TXTexas | $165.92 | $70.40 |
| Rest of TexasTexas | $158.50 | $67.21 |
| UtahUtah | $157.53 | $67.11 |
| VirginiaVirginia | $161.08 | $66.52 |
| Virgin Islands, VIUnited States Virgin Islands | $165.41 | $68.16 |
| VermontVermont | $160.81 | $65.58 |
| Rest of WashingtonWashington | $169.40 | $68.11 |
| King County, WAWashington | $189.95 | $71.91 |
| WisconsinWisconsin | $156.46 | $64.31 |
| West VirginiaWest Virginia | $152.75 | $69.16 |
| WyomingWyoming | $163.03 | $66.84 |
64468 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$147.11
$196.12
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $196.12 | 1 |
| AL | $149.05 | 1 |
| AR | $147.11 | 1 |
| AZ | $160.36 | 1 |
| CA | $173.00–$214.35 | 29 |
| CO | $170.60 | 1 |
| CT | $174.55 | 1 |
| DC | $186.51 | 1 |
| DE | $162.84 | 1 |
| FL | $162.24–$176.29 | 3 |
| GA | $153.97–$167.18 | 2 |
| GU | $176.59 | 1 |
| HI | $176.59 | 1 |
| IA | $152.40 | 1 |
| ID | $153.30 | 1 |
| IL | $158.03–$171.73 | 4 |
| IN | $154.10 | 1 |
| KS | $151.78 | 1 |
| KY | $152.27 | 1 |
| LA | $152.06–$158.83 | 2 |
| MA | $169.75–$186.36 | 2 |
| MD | $165.72–$186.51 | 3 |
| ME | $154.05–$161.54 | 2 |
| MI | $155.85–$164.10 | 2 |
| MN | $163.85 | 1 |
| MO | $149.73–$159.31 | 3 |
| MS | $148.45 | 1 |
| MT | $164.32 | 1 |
| NC | $155.50 | 1 |
| ND | $161.36 | 1 |
| NE | $153.14 | 1 |
| NH | $168.01 | 1 |
| NJ | $176.65–$184.88 | 2 |
| NM | $156.63 | 1 |
| NV | $163.60 | 1 |
| NY | $157.60–$191.93 | 5 |
| OH | $155.25 | 1 |
| OK | $151.99 | 1 |
| OR | $162.42–$175.56 | 2 |
| PA | $155.46–$170.58 | 2 |
| PR | $165.41 | 1 |
| RI | $168.29 | 1 |
| SC | $155.61 | 1 |
| SD | $161.01 | 1 |
| TN | $152.47 | 1 |
| TX | $154.54–$169.95 | 8 |
| UT | $157.53 | 1 |
| VA | $161.08–$186.51 | 2 |
| VI | $165.41 | 1 |
| VT | $160.81 | 1 |
| WA | $169.40–$189.95 | 2 |
| WI | $156.46 | 1 |
| WV | $152.75 | 1 |
| WY | $163.03 | 1 |
How the 64468 rate is calculated
Each of 64468’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 64468
RVUs × geographic indexes × conversion factor
Work1.63
1.63 RVUs× 1.000 GPCI
Practice expense3.14
3.14 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
4.9200
Conversion factor
$33.4009
Medicare rate
$164.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,122
- Code
- 64468
- Physician work
- 1.63
- Practice expense
- 3.14
- Malpractice
- 0.15
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.63 | × 1.000 | 1.6300 |
| Practice expense | 3.14 | × 1.011 | 3.1745 |
| Malpractice | 0.15 | × 0.985 | 0.1477 |
| Total RVUs | 4.9523 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$165.41
Office: (1.63 × 1 + 3.14 × 1.011 + 0.15 × 0.985) × $33.4009 = $165.41
Facility: (1.63 × 1 + 0.26 × 1.011 + 0.15 × 0.985) × $33.4009 = $68.16
Payment rules and modifiers for 64468
The CMS indicators that decide how 64468 is paid alongside other services.
CMS payment indicators · 64468
Thoracic block, bilateral injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
64468 without 51 · national office
$164.33
Thoracic block, bilateral injection
64468-51 · Second procedure: 50%
$82.17
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 64468 has changed in Puerto Rico
64468 · Office / nonfacility
$165.41
Effective 2026-10-01
The base rate is $26.51 higher than on 2025-10-01, moving from $138.90 to $165.41 (19.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$138.90changed to$165.41
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.67 changed to 1.63
- Practice expense RVU 2.45 changed to 3.14
- Malpractice RVU 0.16 changed to 0.15
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
No ratechanged to$138.90
Held through RVU25B, RVU25C, RVU25D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $165.41 | $68.16 | RVU26D |
| 2026-07-01 | $165.41 | $68.16 | RVU26C |
| 2026-04-01 | $165.41 | $68.16 | RVU26B |
| 2026-01-01 | $165.41 | $68.16 | RVU26A |
| 2025-10-01 | $138.90 | $70.83 | RVU25D |
| 2025-07-01 | $138.90 | $70.83 | RVU25C |
| 2025-04-01 | $138.90 | $70.83 | RVU25B |
| 2025-01-01 | $138.90 | $70.83 | RVU25A |
| 2024-10-01 | Not in this release | Not in this release | RVU24D |
| 2024-07-01 | Not in this release | Not in this release | RVU24C |
| 2024-04-01 | Not in this release | Not in this release | RVU24B |
| 2024-03-09 | Not in this release | Not in this release | RVU24AR |
| 2024-01-01 | Not in this release | Not in this release | RVU24A |
| 2023-10-01 | Not in this release | Not in this release | RVU23D |
| 2023-07-01 | Not in this release | Not in this release | RVU23C |
| 2023-04-01 | Not in this release | Not in this release | RVU23B |
| 2023-01-01 | Not in this release | Not in this release | RVU23A |
| 2022-10-01 | Not in this release | Not in this release | RVU22D |
| 2022-07-01 | Not in this release | Not in this release | RVU22C |
| 2022-04-01 | Not in this release | Not in this release | RVU22B |
| 2022-01-01 | Not in this release | Not in this release | RVU22A |
| 2021-10-01 | Not in this release | Not in this release | RVU21D |
| 2021-07-01 | Not in this release | Not in this release | RVU21C |
| 2021-04-01 | Not in this release | Not in this release | RVU21B |
| 2021-01-01 | Not in this release | Not in this release | RVU21A |
| 2020-10-01 | Not in this release | Not in this release | RVU20D |
| 2020-07-01 | Not in this release | Not in this release | RVU20C |
| 2020-04-01 | Not in this release | Not in this release | RVU20B |
| 2020-01-01 | Not in this release | Not in this release | RVU20A |
| 2019-10-01 | Not in this release | Not in this release | RVU19D |
| 2019-07-01 | Not in this release | Not in this release | RVU19C |
| 2019-04-01 | Not in this release | Not in this release | RVU19B |
| 2019-01-01 | Not in this release | Not in this release | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
64468 billing questions
How does 64468 differ from 64466?
64468 describes injection treatment on both sides. 64466 describes the corresponding unilateral injection service.
How does 64468 differ from 64469?
Both describe bilateral thoracic fascial plane blocks, but 64468 is for injections and 64469 is for continuous infusion.
Should modifier 50 be appended?
The code is already priced as bilateral, and modifier 50 does not increase payment. Document that the block was performed on both sides.
Can imaging guidance be billed separately?
Imaging guidance, when performed, is included in the thoracic fascial plane block service.
What documentation supports reporting 64468?
Document the thoracic fascial plane sites, bilateral treatment, anesthetic injected, and reason for the block, such as perioperative chest-wall analgesia.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple-procedure reduction. The 0-day global period includes same-day preoperative and postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 64468 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist