CPT 64469
Global 000 ActiveThrc fascial pln blk bi nfs
CPT 64469 Billing & Documentation Guide
CPT code 64469 (Thrc fascial pln blk bi nfs) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.78, a non-facility practice expense RVU of 10.54, and a malpractice RVU of 0.17, a total non-facility RVU of 12.49 and facility RVU of 2.24. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $432.94, though rates vary from $364.78 to $576.69 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 64469, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 64469 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 64469 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 64469
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.78 | 1.78 |
| Practice Expense RVU | 10.54 | 0.29 |
| Malpractice RVU | 0.17 | 0.17 |
| Total RVU | 12.49 | 2.24 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 64469
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $481.23 | $76.12 | $449.35 - $576.69 | 29 |
| Florida | $423.72 | $80.23 | $404.54 - $440.29 | 3 |
| Georgia | $402.19 | $75.58 | $380.25 - $424.13 | 2 |
| Illinois | $410.68 | $79.87 | $389.75 - $431.48 | 4 |
| Michigan | $398.02 | $76.54 | $387.28 - $408.75 | 2 |
| North Carolina | $391.54 | $72.12 | $391.54 - $391.54 | 1 |
| New York | $462.73 | $80.8 | $397.89 - $492.39 | 5 |
| Ohio | $386.59 | $74.02 | $386.59 - $386.59 | 1 |
| Pennsylvania | $410.89 | $75.54 | $388 - $433.78 | 2 |
| Texas | $411.64 | $74.59 | $385.09 - $437.07 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 64469
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 64469 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01991 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01992 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0333T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0464T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0543T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0545T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0563T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0565T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0566T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 64469
What does CPT code 64469 mean? +
CPT code 64469 represents: Thrc fascial pln blk bi nfs. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 000.
What is the Medicare reimbursement for CPT 64469? +
The 2026 Medicare national average non-facility payment for CPT 64469 is $432.94. Rates range from $364.78 to $576.69 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 64469? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 64469? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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