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[DATE][CARRIER MEDICAL DIRECTOR][CARRIER][CARRIER ADDRESS][CITY, STATE, ZIP]Re: Addition of Applicable 90000 Series CPT Codes to 63 Modifier Descriptor - Appropriate Payment of Modifier 63 Appended Claims ExpectedDear [CARRIER MEDICAL DIRECTOR],The Society for Cardiovascular Angiography and Interventions (SCAI) is a non-profit professional association with over 4,500 members representing the majority of practicing interventional cardiologists and cardiac catheterization teams in the United States including pediatric interventional cardiologists treating patients with congenital heart disease. SCAI promotes excellence in interventional cardiovascular medicine through education, representation and the advancement of quality standards to enhance patient care. At the September 2018 AMA CPT Advisory Panel meeting, SCAI successfully secured revision to the descriptor of modifier -63 to include applicable 90000 series CPT codes. The purpose of the 63 modifier is to support additional reimbursement to reflect 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 goal of this recent revision to the modifier 63 descriptor was to include applicable cardiac catheterization procedures for small infants born with heart defects. As you can imagine, such procedures are extremely challenging, time consuming and stressful for the operator. The revision to the modifier 63 descriptor goes into effect on January 1, 2020. Pediatric interventional cardiologists across the United States will start appending modifier 63 as applicable for billing purposes. Unlike modifier 22, which is typically accepted by payers, when supported with appropriate additional documentation, some payers have historically not recognized the additional physician work and applicable additional reimbursement associated with modifier 63. Some payers have incorrectly instructed their staff that the 63 modifier is not to be used to report procedures performed to treat congenital defects. This is incorrect and in fact, the far majority of procedures for which an infant < 4 kg would have any given procedure is a congenital defect. The AMA CPT guidelines do not instruct any limitation for use of modifier 63 due to presence of a congenital defect. SCAI urges all payers to acknowledge the complexity and difficulty of performing these procedures on such small infants and recognize the validity of the 63 modifier as accepted and approved by the AMA and CMS. Surgical or applicable cardiovascular services modified with modifier 63 (procedure performed on infants less than 4 kg) shall be reimbursed at 125 percent of the agreed upon carrier fee schedule. If SCAI can be of any assistance as CMS continues to consider and review these issues, please do not hesitate to contact Mr. Curtis Rooney, Vice President, Government Relations at (202) 216-2987or crooney@.Sincerely, left69850Ehtisham Mahmud, MD, FSCAIFormer SCAI President, 2019-2020Ehtisham Mahmud, MD,?FSCAIPresident, Society for Cardiovascular Angiography and InterventionsEdith and William Perlman Chair in CardiologyProfessor and Division Chief, Cardiovascular MedicineExecutive Director, UCSD Cardiovascular Institute-MedicineUniversity of California, San DiegoPh: (858) 657-8030Fax: (858) 657-8032email: emahmud@ucsd.eduCC: [REQUESTING SCAI MEMBER][STATE INSURANCE COMMISSIONER]Curtis Rooney, Vice President, Government Relations, crooney@ ................
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