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Question:
Can you provide information about when it is appropriate to use modifier 63?
Answer:
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.
CPT® copyright 2021 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
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