2025 CPT code 64461
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Nervous System Feed
Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes imaging guidance, when performed)
Modifiers may be applicable. Modifier 50 is used for bilateral procedures. Other modifiers, such as those indicating reduced services or unusual circumstances, may also be appropriate depending on the specific case.
Medical necessity for a thoracic paravertebral block is established by documenting the condition being treated (e.g., post-operative pain, rib fractures) and the expected benefit of pain relief. It must be clear the block is necessary for pain control and contributes to the patient’s overall wellbeing.Payor-specific policies must be considered.
The provider prepares the patient's skin with antiseptic and identifies the injection site. After locating the paravertebral space, the anesthesia is injected. Imaging guidance may be used to ensure accurate needle placement.
In simple words: A single injection of local anesthetic is administered near the spine in the upper and mid-back area to block pain signals. This procedure, often used after thoracic surgery or for conditions like rib fractures, provides targeted pain relief.The procedure includes image guidance (like a live x-ray) if used.
The provider injects local anesthesia at a single site in the spaces beside or around the vertebrae of the thoracic spine. This results in a nerve blockade which relieves pain. The provider typically performs this type of anesthesia after thoracic surgery for postsurgical pain relief or on patients before breast surgery or patients with rib fractures. Image guidance (live, real–time imaging projected on a video monitor) is included when performed.
Example 1: A patient undergoes a thoracotomy and receives a thoracic paravertebral block for post-operative pain management., A patient with multiple rib fractures receives a thoracic paravertebral block for pain control., A patient undergoing breast surgery receives a thoracic paravertebral block as part of the anesthetic plan.
Documentation should include the specific site of injection, type and amount of anesthetic used, use of image guidance (if any), and the patient's response to the block.
- Specialties:Anesthesiology, Pain Management, Surgery (Thoracic, General)
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center