Effective July 1, 2025, CMS has updated its Procedure-to-Procedure (PTP) Edits, impacting billing practices for thoracic fascial plane blocks. Under these revisions, thoracic fascial plane CPT codes are now bundled with specific ASA anesthesia codes. These edits were posted to the CMS Medicare NCCI Procedure-to-Procedure (PTP) Edits website on June 2, 2025.
What Does This Mean?
When performed in conjunction with anesthesia for certain procedures, applicable thoracic fascial plane blocks will no longer be billed separately. Under current CMS edits, these blocks are now considered part of the bundled anesthesia service.
Injection sites impacted by this change include the erector spinae and pectoralis blocks.
- For example, a bilateral pectoralis block performed during anesthesia for sternal debridement will no longer be billed separately. This was previously represented using CPT 64468 alongside ASA code 00550.
However, billing remains permissible for thoracic fascial plane block CPT codes when paired with ASA codes not listed in the affected edits.
- For instance, documentation and claim submission will continue for a bilateral erector spinae block performed during anesthesia for a one-lung thoracotomy.
Reference Table
We’ve provided a detailed table outlining the affected CPT and ASA code combinations to support your understanding and planning.
| CPT Code | ASA Code |
|---|---|
| 64466 – Thoracic fascial plane block; unilateral injection | 00500, 00539, 00550, 00560, 00561, 00562, 00563, 00566, 00567, 00580, 00600, 00620, 00670 |
| 64467 – Thoracic fascial plane block; unilateral continuous infusion | 00500, 00539, 00550, 00560, 00561, 00562, 00563, 00566, 00567, 00580, 00620, 00670 |
| 64468 – Thoracic fascial plane block; bilateral injection | 00500, 00539, 00550, 00560, 00561, 00562, 00563, 00566, 00567, 00580, 00620 |
| 64469 – Thoracic fascial plane block; bilateral continuous infusion | 00500, 00539, 00550, 00560, 00561, 00562, 00563, 00566, 00567, 00580, 00620 |
Impacted ASA Codes Include:
- Anesthesia for sternal debridement
- Tracheobronchial reconstruction
- Procedures involving the heart, pericardial sac, and great vessels (regardless of age or use of pump oxygenator)
- Direct coronary artery bypass grafting (with or without pump oxygenator)
- Heart/lung transplant
- Thoracic spine and cord procedures
- Cervical spine and cord procedures
- Extensive spinal cord procedures
Advocacy Update
The ASA has requested CMS reconsider these edits. Providers are encouraged to share feedback directly with NCCI by emailing NCCIPTPMUE@cms.hhs.gov.
