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PAP 274

CPT Modifier 63


Provider Administrative Policy

Section
Claims Submission
Policy Date
June 2012
Status/Date
New/June 2012
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

CPT Modifier 63

CPT modifier 63 is intended to describe a significant increase in physician work and complexity related to invasive surgery on neonates and infants up to a present body weight of 4kg. There is more work and complexity due to temperature control, obtaining IV access, maintenance of hemostasis, etc. The additional work effort must be documented in the medical record. Blue Cross of Idaho subjects all claim lines with a modifier 63 to a clinical review. After appropriate use of modifier is validated, reimbursement will be at an additional 20 percent of the allowable.


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