Cardiology Question for the Week of January 21, 2019

Cardiology Compliance Question of the Week


Can you provide information about when it is appropriate to use modifier 63?


According to the Centers for Medicare & Medicaid Services (CMS), you will now be able to append modifier 63 (procedure performed on infants less than 4 kgs.) to select Medicine/Cardiovascular (90000-series) codes to describe increased complexity of procedures performed on patients of less than 4 kg (approx. 8.8 lb.). Note that CPT does not allow modifier 63 for procedures involving congenital anomalies, or those valued to reflect heightened complexity associated with prematurity. See the 2019 CPT manual appendix F for more information about modifier 63 exempt codes.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.