Is your office compliant- uses the proper codes for facia plane blocks?
Back in 2025 CMS released new and updated facia plane block codes to better represent the work that the anesthesiologists perform to reduce the pain for the patients during procedures (thorasic/lower extremity).
Imaging is included in these codes.
Please note if the EP block is performed in the lumbar region, these codes are not appropriate and the code 64999 should be
used.
Coding:
Images are via ASA websiteImage via ASA website
Make sure your office is compliant and uses the proper codes to capture the procedures.
Please note that this policy update applies to the members that have commercial plan types.
The affected codes: for any DOS on or after Jan 1st 2026, Aetna will consider the following codes for compression stockings to be a disposable supply and a standard benefit exclusion.
Codes:
For Texas Providers:
These changes apply to fully insured plans written in Texas and only if such changes are in accordance with applicable regulatory requirements. Changes for all other plans will be as outlined in this article.
Find this type of content useful? Follow my blog for more payer updates. #medicalbilling #medicalcoding #reimbursement
In order for us to understand the coding difference between the nursing home visit codes and PDN (private duty nursing) codes, we need to go back to the basics.
Definitions:
Nursing Home services/visits- the necessary intermittent or part-time nursing care provided for a patient in the patient’s home or home substitute on a per visit basis. These services are usually no more than 2 hours per day and are performed by the Certified Home Health Agency.
Private Duty Nursing services/visits- nursing services that are one on one more personal level, for medical fragile members, that are performed on continuous basis. The purpose of Private Duty Nursing is to assist the caregiver/family members to help the member to remain safely at home. There is a separate code set for PDN services and a corresponding fee schedule.
image is via NYS Medicaid website
Reimbursement:
Nursing Home Visits: are reimbursed in the increments of 15 min
PDN services/visits: are reimbursed by hour.
Exception: the following 2 code are reimbursed per diem because they represent the 13-hour shift
T1030- nursing care by RN, per diem, at home- 13 hour shirt
T1031- nursing care by LPN, per diem, at home- 13-hour shift
Coding–
I. Nursing Home Visits/Services:
a. T1002- RN services, up to 15 min
b. T1003- LPN services, up to 15 min
II. PDN services/visits:
a. S9123- RN services, per hour
b. S9124- LPN services, per hour
Please note that when you are billing the T codes you cannot bill them with the “other nursing codes” , listed below, or when the codes listed below better represent the nursing services that are authorized, performed.
Other Nursing Codes:
image via UHC website
Need more information about NYS Medicaid Home and Community LTC codes: please visit here
KR2 Medical Billing 