Billing code 64469: Thoracic plane blockMedicare rate & RVUs in Virginia
Reports bilateral thoracic fascial plane analgesia delivered by continuous catheter infusion, including catheter placement, for perioperative or other pain management.
Medicare pays $409.52–$483.69 for 64469 in the office in Virginia, from Virginia to Dc + Md/Va Suburbs. Which amount applies depends on the service address.
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 9 sections
What 64469 covers
This service establishes continuous local anesthetic delivery through catheters placed in thoracic fascial planes on both sides. Anesthesiologists and other qualified pain-management clinicians may use it for analgesia involving the chest wall, including around thoracic or breast procedures. Imaging guidance may be used when appropriate. The continuous catheter technique distinguishes this service from a block delivered as a single injection.
Report the bilateral continuous-infusion service when documentation supports catheter placement and ongoing infusion on both sides. The code is priced as bilateral, so modifier 50 does not increase payment. CMS assigns a 0-day global period, which includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment is restricted; 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.
Where 64469 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | $483.69 | $80.39 |
| Virginia | $409.52 | $72.98 |
How the 64469 rate is calculated
Each of 64469’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 · 64469
RVUs × geographic indexes × conversion factor
Work1.78
1.78 RVUs× 1.000 GPCI
Practice expense10.54
10.54 RVUs× 1.000 GPCI
Malpractice0.17
0.17 RVUs× 1.000 GPCI
Adjusted RVUs
12.4900
Conversion factor
$33.4009
Medicare rate
$417.18
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 64469
The CMS indicators that decide how 64469 is paid alongside other services.
CMS payment indicators · 64469
Thoracic plane block
| 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
64469 without 51 · national office
$417.18
Thoracic plane block
64469-51 · Second procedure: 50%
$208.59
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%).
64469 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 64468Thoracic block
- Choose 64468 for a bilateral thoracic fascial plane block performed as a single injection. Use 64469 when bilateral catheters provide continuous infusion.
- 64467Thoracic plane block
- 64467 describes continuous catheter infusion on one side; 64469 describes the bilateral service.
- 64463Paravertebral block
- 64463 is a thoracic paravertebral continuous-infusion block. 64469 is for a thoracic fascial plane approach.
64469 billing questions
How does this differ from 64468?
64469 represents bilateral thoracic fascial plane catheters for continuous infusion. 64468 is the corresponding bilateral single-injection service.
Should modifier 50 be appended?
The code is already priced as bilateral, and modifier 50 does not increase payment. Document that the service was performed on both sides.
What supports reporting the continuous-infusion service?
The record should identify bilateral catheter placement and the plan for continuous infusion. A single injection without continuous catheter delivery points to the single-injection code instead.
Is same-day postoperative care separately included?
The code has a 0-day global period, which includes same-day preoperative and postoperative care.
How does CMS handle another procedure performed in the same session?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
Can an assistant, co-surgeon, or surgical team be paid for this service?
CMS restricts assistant-at-surgery payment for this code. Co-surgeons and team surgery are not permitted.
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
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