The ACC and the Society for Cardiovascular Angiography and Interventions (SCAI) have successfully advocated for a revision to the descriptor of CPT^® modifier -63 to now include applicable codes in the 90000 series of the American Medical Association's CPT book.

The purpose of the -63 modifier is to support additional reimbursement to reflect the increased complexity and physician work commonly associated with procedures for infants up to a present body weight of 4 kg. Modifier -63 is to be appended to procedures performed on neonates and infants up to a body weight of 4 kg.

Previously one could only append modifier -63 to procedures listed in the 20100-69990 codes series. As of Jan. 1, physicians and other qualified health care professionals can also append the modifier -63 to the following procedures codes: 92920, 92928, 92953, 92960, 92986, 92987, 92990, 92997, 92998, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93452, 93505, 93530, 93531, 93532, 93533, 93561, 93562, 93563, 93564, 93568, 93580, 93582, 93590, 93591, 93592, 93615, 93616.

Modifier -63 should not be confused with Modifier -22. Modifier -22 is for increased procedural services and can be appended to any procedure when the work required to provide the service is substantially greater than typically required.

Email dmariani@acc.org if you have any questions.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Clinical Coding, Angiography

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