Summary & Overview
CPT 64461: Thoracic Paravertebral Injection, Single Level
CPT code 64461 denotes a thoracic paravertebral injection of local anesthetic at a single thoracic vertebral level to produce a regional nerve block for chest- or thorax-related pain. The procedure has clinical importance across surgical and trauma care for managing postoperative thoracic pain, providing preoperative analgesia for breast surgery, and treating pain from rib fractures. Nationally, use of this regional block affects inpatient and ambulatory anesthesia practice patterns and postoperative pain-management strategies.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find operational and clinical context about the service type and typical sites of service, as well as benchmarking and policy-relevant discussion where available. The publication summarizes coding intent, common clinical indications, and typical care settings, and outlines areas where payers commonly apply coverage or utilization controls. Data not available in the input is noted where applicable.
This summary is intended for clinicians, billing professionals, and policy analysts seeking a concise reference to the clinical purpose and payer landscape for CPT code 64461, helping stakeholders understand where the procedure fits into perioperative and trauma pain-management pathways.
Billing Code Overview
CPT code 64461 describes a thoracic paravertebral injection of local anesthetic at a single vertebral level, producing a nerve blockade to relieve thoracic or chest-wall pain. The procedure is commonly performed for postsurgical analgesia after thoracic procedures, for preoperative anesthesia for breast surgery, and for pain control in patients with rib fractures. Image guidance (live, real-time imaging projected on a video monitor) may be used during the procedure.
Service Type: Regional/local anesthesia procedure
Typical Site of Service: Hospital operating room or post-anesthesia care area, ambulatory surgery center, or acute hospital setting for postsurgical or trauma-related chest pain management
Clinical & Coding Specifications
Clinical Context
A 58-year-old female presents on postoperative day one after a right-sided thoracotomy for lung resection. She reports severe ipsilateral chest wall and incisional pain limiting deep inspiration and ambulation. The acute pain service evaluates her and recommends a thoracic paravertebral block for targeted unilateral analgesia. The patient is consented, placed in a sitting or lateral decubitus position, and standard monitoring is applied. After sterile preparation, the provider identifies the appropriate thoracic level using anatomic landmarks or ultrasound guidance. Local anesthetic is injected into the paravertebral space at a single thoracic level to produce unilateral somatic and sympathetic nerve blockade. The procedure may be documented with real-time imaging if used. Post-procedure monitoring includes assessment of pain scores, respiratory function, hemodynamics, and sensory level. Typical sites of service include the hospital inpatient ward, post-anesthesia care unit, or ambulatory surgical center when performed preoperatively for breast surgery or post-trauma in the emergency department.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | When another service or injection was performed at a separate anatomic site during the same encounter and not ordinarily bundled. |
62 |