Description of the 33 modifier, billing guidelines and costs are described below.
Modifier 33 Description
The official description of Modifier 33 is: “Preventive Service.”
When the primary purpose of the service is the delivery of an evidence-based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by appending modifier 33, Preventive Service, to the service.
For separately reported services specifically identified as preventive, the modifier should not be used. The most notable example of this is screening colonoscopy (CPT 45378), which results in a polypectomy (CPT 45383).
When Is Modifier 33 Applicable?
The 33 modifier is applicable for the identification of preventive services without cost -sharing in these four categories:
Immunizations for routine use in children, adolescents, and adults as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
Preventive care and screenings for children as recommended by Bright Futures (American Academy of Pediatrics) and Newborn Testing (American College of Medical Genetics) as supported by the Health Resources and Services Administration.
Preventive care and screenings provided for women (not included in the Task Force recommendations) in the comprehensive guidelines supported by the Health Resources and Services Administration.
Modifier 33 Billing Guidelines
CPT modifier 33 should be appended to codes representing the preventive services, unless the service is inherently preventive, eg, a screening mammography or immunization recognized by the Advisory Committee on Immunization Practices (ACIP).
If multiple preventive medicine services are provided on the same day, the modifier is appended to the codes for each preventive service rendered on that day.
Cost Sharing Of Modifier 33
The regulations specify that plans cannot impose cost-sharing requirements, such as co-pays, coinsurance, or deductibles with respect to specified preventive services in which preventive services are billed separately.
When these services are part of an office visit, the office visit may not have cost-sharing if the primary reason for the visit is to receive preventive services.
However, cost-sharing is permitted for an office visit when the office visit and covered preventive services are billed separately, and the primary purpose of the office visit is not delivery of the covered preventive services.