Summary & Overview
CPT 64449: Continuous Lumbar Plexus Nerve Block via Catheter
CPT code 64449 represents continuous infusion lumbar plexus nerve block via an indwelling catheter, including catheter placement and administration of an anesthetic agent, steroid, or both. This regional anesthesia procedure is used to maintain prolonged analgesia or anesthesia to the lower extremity and is clinically relevant for perioperative pain control, trauma care, and extended postoperative analgesia. Nationally, correct coding and clinical documentation for continuous peripheral nerve catheters affect utilization monitoring, payer coverage determinations, and aggregated procedure volume reporting.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of the clinical service and typical sites of care, guidance on common billing considerations, and an outline of the types of benchmarks and policy topics typically associated with continuous regional anesthesia codes. The publication highlights where data is available and notes when input fields are not provided.
The report is intended for clinicians, coding professionals, and policy analysts seeking an authoritative description of CPT code 64449, expected use cases, and the payer landscape relevant to continuous lumbar plexus catheter infusions.
Billing Code Overview
CPT code 64449 describes continuous infusion nerve block of the lumbar plexus delivered via an indwelling catheter. The service involves placement of a catheter and administration of an anesthetic agent, steroid, or both to maintain regional anesthesia of the lower extremity for the duration clinically required. Catheter placement is included in the service and should not be reported separately.
Service type: Continuous peripheral nerve blockade with catheter
Typical site of service: Inpatient or outpatient procedural settings where regional anesthesia is provided, such as operating rooms, ambulatory surgical centers, or acute care units.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with severe, localized postoperative or chronic lumbar plexus–mediated lower extremity pain undergoes placement of a continuous lumbar plexus catheter for ongoing regional analgesia. Typical indications include major lower-extremity orthopedic surgery (total hip arthroplasty, femur fracture fixation) requiring prolonged postoperative analgesia, or intractable neuropathic or cancer-related pain localized to the lumbar plexus distribution when a continuous nerve block is appropriate.
The clinical workflow: pre-procedure evaluation (history, allergy review, anticoagulation check, informed consent), positioning (typically lateral decubitus or prone), ultrasound and/or fluoroscopic localization of the lumbar plexus, sterile preparation and local skin infiltration, needle advancement to position the catheter adjacent to the lumbar plexus, confirmation of correct placement (nerve stimulation and/or contrast/ultrasound spread), tunneling/securement of the catheter, initiation of continuous infusion of local anesthetic with or without steroid per protocol, monitoring in PACU or inpatient unit, and catheter removal when analgesic goals are met. Documentation includes indication, site, technique, agents and concentrations used, catheter insertion included in the single code 64449, infusion parameters, complications, and patient response.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |