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    Pediatric Cardiologists Can Now Use of Modifier -63 to Bill for Extra Costs of Caring for Infants

    March 06, 2020

    SCAI has gotten the AMA and its CPT Editorial Panel to state that it is appropriate to use modifier -63 on 90000 series CPT codes. The description of modifier has been modified to allow its use with 90000 series CPT codes starting in 2020. The -63 modifier supports additional charges due to the increased complexity of procedures for infants under 4 kg. Unlike modifier -22, which has a much broader application, modifier -63 is specific to infants under 4 kilograms of bodyweight.  The primary application of the modifier will be in cardiac catheterization procedures on small infants born with congenital heart defects. 

    It will take time and effort to get all payers to cover these charges and so SCAI has developed this draft letter to payers for your use. When you do, please let SCAI staff know and we will work to coordinate the efforts of members in this effort. SCAI appreciates the leadership of Sergio Bartakian, MD, FSCAI  in resolving this coding problem. If SCAI can be of any assistance in working with your local payers, please contact Wayne Powell at 703.772.7910 or wpowell@scai.org.