Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member, please register here.

If you are a Medicare Advantage or Medicare Supplement member, please register here.

PAP 274

CPT Modifier 63

Provider Administrative Policy

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


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.


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.

Policy History

Date Action Reason

Search for Policies

Policy Feedback

Resource Center

Find a Provider Find a Pharmacy Medicare Medicare Formulary