2025 CPT code 64449

Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement).

Follow CPT guidelines for nerve blocks. Ensure proper documentation to support medical necessity and accurate code selection.

Modifiers 50 (bilateral procedure) may apply if bilateral lumbar plexus blocks are performed.Other modifiers (e.g., 22, 59) may be appropriate depending on the specific circumstances of the service.

Medical necessity for 64449 is established when a patient requires continuous postoperative analgesia after major lower limb surgery. This is particularly relevant when alternative pain management strategies are insufficient or contraindicated. The documentation should clearly justify the need for a continuous infusion block rather than intermittent injections.

The physician is responsible for selecting the appropriate anesthetic agent and/or steroid, determining the dosage, inserting the catheter, and managing the continuous infusion pump to deliver the medication. They must also monitor the patient for any adverse effects of the anesthetic.

IMPORTANT Do not report 64449 in conjunction with 01996 (Daily hospital management of continuous spinal drug administration).

In simple words: The doctor injects medicine (numbing and/or anti-inflammatory) near the nerves in the lower back to provide continuous pain relief.This is often done after major leg or hip surgery, with a small tube left in place for ongoing medication delivery via a pump. The placement of this tube is included in the procedure.

This CPT code, 64449, reports the injection of an anesthetic agent and/or steroid into the lumbar plexus via a posterior approach using continuous infusion through an indwelling catheter. The catheter placement is inclusive to this code and should not be billed separately.This procedure is typically used for postoperative pain management following major lower limb surgery such as hip, knee, or anterior thigh surgeries. The method involves inserting a catheter into the iliopsoas compartment near the lumbar plexus, then using a continuous infusion pump to deliver the anesthetic agent and/or steroid as needed. The provider monitors the patient for signs of complications, such as respiratory distress or hypotension, and verifies the effectiveness of the block.Daily management of the infusion and medication administration are considered part of the procedure.Imaging guidance (ultrasound) may be reported separately.

Example 1: Postoperative pain management following total knee arthroplasty. A continuous lumbar plexus block using 64449 is implemented to manage postoperative pain and facilitate early mobilization., Pain management after a hip fracture repair.A continuous lumbar plexus block is used to provide effective analgesia and aid in patient comfort during the recovery period., Treatment of chronic pain from lumbar radiculopathy. A continuous lumbar plexus block is considered in cases where conservative treatment options have failed to provide adequate relief.

* Detailed history and physical examination notes documenting the indication for the procedure.* Documentation of the type and amount of anesthetic agent and/or steroid used.* Documentation of the technique used for catheter placement (posterior approach).* Confirmation of catheter placement using appropriate imaging (e.g., fluoroscopy, ultrasound) if utilized.* Documentation of the duration of the continuous infusion.* Post-procedure notes documenting patient's response to the block and any adverse events.* Operative report for associated procedures.

** Some payers may require preauthorization or may not cover continuous infusion techniques. Verify payer-specific policies before providing the service and submitting the claim.

  • Revenue Code: P6C (MINOR PROCEDURES - OTHER)
  • Payment Status: Active
  • Modifier TC rule: Technical component (TC) modifiers are not applicable to 64449 as the code encompasses the entire service.
  • Specialties:Anesthesiology, Pain Management, Orthopedic Surgery
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center
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