Modifier 33 | Preventive Services Explained
Modifier 33 can be used for preventive services with an A or B rating from the U.S. Preventive Services Task Force. These services are intended to prevent or detect illnesses or conditions early, and most insurance plans cover them without cost-sharing. By appending modifier 33 to the CPT code of the service, medical coders can inform the payer that the service is a preventive service and that the patient’s deductible and coinsurance do not apply.
1. What is modifier 33?
Modifier 33 is a billing modifier used in medical coding to indicate that a service provided to a patient is a preventive service. It is appended to the CPT code of the service to inform the payer that the service is a preventive service and that the patient’s deductible and coinsurance do not apply under the new Patient Protection and Affordable Care Act rules.
2. When to use the 33 modifier?
Modifier 33 should be used when a service provided to a patient is a preventive service with an A or B rating from the U.S. Preventive Services Task Force. It should not be used for inherently screening services and contain the word screening in the descriptor, such as a screening mammogram.
3. Description
The official description of modifier 33 is “Preventive service.”
4. Requirements
Before using modifier 33, the service must be a preventive service with an A or B rating from the U.S. Preventive Services Task Force. The service must also be provided to a patient eligible for preventive services under the Patient Protection and Affordable Care Act. The documentation of the service must indicate that it is a preventive service.
5. Examples
Examples of procedures that require modifier 33 include:
- Annual wellness visits
- Colorectal cancer screenings
- Diabetes screenings
- High blood pressure screenings
- Obesity screenings
6. Documentation
The documentation of the service must indicate that it is a preventive service. The documentation should include the name of the preventive service, the date it was provided, and the service results, if applicable.
7. Billing
To bill for a preventive service with modifier 33, the CPT code for the service should be appended with modifier 33. The claim should also indicate that the service is preventive and that the patient’s deductible and coinsurance do not apply.
8. Common mistakes
Common mistakes that medical coders make when using modifier 33 include:
- Using it for services that are not preventive
- Failing to document that the service is a preventive service
- Failing to indicate that the patient’s deductible and coinsurance do not apply
To avoid these mistakes, medical coders should carefully review the documentation of the service and ensure that it meets the requirements for using modifier 33.
9. Other modifiers related to modifier 33
Other modifiers related to modifier 33 include:
- Modifier 25: Used to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as a preventive service
- Modifier 59: Used to indicate that a service was distinct or independent from other services provided on the same day
10. Tips
When using modifier 33, medical coders should:
- Ensure that the service provided is a preventive service with an A or B rating from the U.S. Preventive Services Task Force
- Document that the service is a preventive service
- Indicate that the patient’s deductible and coinsurance do not apply
- Review the documentation carefully to avoid common mistakes
11. Conclusion
Modifier 33 is a billing modifier used in medical coding to indicate that a service provided to a patient is a preventive service. It should be used for services with an A or B rating from the U.S. Preventive Services Task Force and should not be used for services inherently screening services. Review the documentation of the service and ensure that it meets the requirements for using modifier 33.
