All PlansAdministrativeLow impact
PAP274 - CPT Modifier 63 and SZ - Modifiers KX and condition code 45 removed.
Blue Cross of Idaho·ID · Pediatrics, General Surgery, Physical Therapy +1 more·Coding
Effective date
Dec 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated policy PAP274 to remove references to modifiers KX and condition code 45, while keeping guidance for CPT modifier 63 (for neonatal/infant surgery up to 4kg) and HCPCS modifier SZ (for habilitative services). The policy was simplified by removing previously included modifiers.
Action Required
Immediately: Review current billing practices to ensure modifier KX and condition code 45 are no longer being used per Blue Cross of Idaho requirements. Continue using CPT modifier 63 for neonatal/infant surgeries (patients up to 4kg) with proper documentation, and HCPCS modifier SZ for habilitative services to maintain visit limit tracking.