Summary & Overview
CPT 64462: Thoracic Paravertebral/Add-on Regional Nerve Block
CPT code 64462 denotes an add‑on thoracic paravertebral or intercostal space nerve block in which an additional injection of local anesthetic is performed beside or around thoracic vertebrae to achieve regional analgesia. This procedure is commonly used for postoperative pain control after thoracic or breast surgery and for management of pain from rib fractures. As an add‑on code, 64462 supplements a primary block service and may be performed with image guidance.
Nationally, this code is relevant to hospitals, ambulatory surgery centers, and anesthesia practices managing perioperative and trauma-related thoracic pain. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The code’s use affects perioperative pain pathways, utilization of regional anesthesia techniques, and billing for multimodal analgesia strategies.
Readers will find a concise overview of clinical indications and service contexts, payer coverage considerations, and operational benchmarks where available. The publication also summarizes typical sites of service and procedural context for 64462, and notes where input data is not available. This resource is intended to clarify coding identity and clinical purpose for administrators, coders, and clinicians involved in thoracic perioperative pain management.
Billing Code Overview
CPT code 64462 is an add-on peripheral nerve block procedure in which a provider injects local anesthetic at an additional site in the spaces beside or around the thoracic vertebrae to produce a nerve blockade and relieve pain. The procedure is typically performed for postoperative thoracic pain control after thoracic surgery, as part of perioperative analgesia for breast surgery, and for rib fracture pain management. The description indicates that the provider may use live, real–time image guidance projected on a video monitor while performing the injection.
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Service type: Regional peripheral nerve blockade / postoperative and acute pain management
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Typical site of service: Inpatient or outpatient surgical settings, hospital post-anesthesia care units, and ambulatory surgery centers where thoracic or breast procedures and acute trauma care (rib fractures) occur.
Clinical & Coding Specifications
Clinical Context
A 58‑year‑old female presents on postoperative day two following a right thoracotomy for lung resection and reports severe, localized thoracic pain (8/10) limiting deep breathing and ambulation. The acute pain service evaluates the patient and recommends an additional thoracic paravertebral block for postoperative analgesia. The provider obtains informed consent, prepares the patient in a monitored setting (vitals, IV access), and uses aseptic technique. With the patient sitting or lateral decubitus, real‑time image guidance (ultrasound) is used to identify the paravertebral space adjacent to the targeted thoracic vertebrae. After local skin anesthesia, the clinician advances a needle into the paravertebral space at an additional level, aspirates to avoid intravascular placement, and injects local anesthetic to produce a unilateral segmental nerve blockade. The patient is observed for immediate complications (hypotension, local anesthetic systemic toxicity, pneumothorax) and for analgesic effect prior to transfer back to the ward. This add‑on injection is billed in addition to the initial paravertebral injection when performed at a separate adjacent site for expanded dermatomal coverage, commonly for postsurgical thoracic pain, rib fractures, or preoperative analgesia for breast surgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | When the additional injection is separate/anatomic and not normally billed with the primary procedure to indicate a distinct service |