Modifier 33

Modifier 33: 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 adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.
The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this guideline does not imply that the service described by the code is a covered or noncovered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and Coverage Determination Guidelines may apply.
Modifier 33
UnitedHealthcare considers the procedures and diagnostic codes and Preventive Benefit Instructions listed in the table below in determining whether preventive care benefits apply. While modifier 33 may be reported, it is not used in making preventive care benefit determinations.
Definitions Section: Added definition of Modifier 33.
Coding Section:
 Added Modifier 33 statement.
 Osteoporosis Screening:
o Updated USPSTF ‘B’ rating description to align with January 2011 USPSTF Recommendation Statement.
o Deleted the “C” rating that was part of the previous USPSTF Recommendation Statement.
 Screening for Visual Impairment in Children:
o updated USPSTF ‘B’ rating description to align with January 2011 USPSTF Recommendation Statement.
 Code Descriptions Updated:
o 82952 and G0437 (Updated descriptions are effective 1/1/11.)
 Codes Added:
o Abdominal Aortic Screening: 76700, 76705
o Cervical Cancer Screening: P3000, P3001
o Hepatitis B Screening: 87340, 87341
o HIV Screening: ICD9 diagnosis code V73.89
o Wellness Examinations: 99461, S0610, S0612, S0613
o Behavior Counseling/Healthy Diet: S9470
 Codes Deleted:
o Immunizations: 90470 (Code was retro terminated back to 12/31/10.)
o Hepatitis B Screening: 87515, 87516, 87517
o HIV Screening: 87534, 87535, 87536, 87537, 87538, 87539
 Modifier 33 – Preventive Services: when the primary purpose of the service is the delivery of an evidence based service in accordance with a USPSTF A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.
In addition, deductible is not applied to claim lines with HCPCS 00810 services that are billed with the PT modifier for services on or after January 1, 2015. The deductible is also not applied when the PT modifier is appended to at least either one of the CPT codes within the surgical range of CPT codes (10000-69999) or HCPCS codes G6018-G6028 on the claim for services that were furnished on the same date of service as the procedure. But, MACs will apply deductible and coinsurance to claim lines for HCPCS 00810 services billed without modifier 33 or modifier PT.
Tips for Billing CPT Modifier 33
The modifier 33 was created to aid compliance with the Affordable Care Act (ACA) which prohibits member cost sharing for defined preventive services for nongrandfathered health plans. The appropriate use of modifier 33 reduces claim adjustments related to preventive services and your corresponding refunds to members. Modifier 33 is applicable to CPT codes representing preventive care services. CPT codes not appended with modifier 33 will process under the member’s medical or preventive benefits, based on the diagnosis and CPT codes submitted.
Modifier 33 should be appended to codes represented for services described in the US Preventive Services Task Force (USPSTF) A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and certain guidelines for infants, children, adolescents, and women supported by the Health Resources and Services Administration (HRSA) Guidelines.
The CPT® 2016 Professional Edition manual shares the following information regarding the billing of modifier 33, “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 mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.”
Modifier 33
Tufts Health Plan accepts and recognizes the use of modifier 33 when billed with services on the U.S. Preventive Services Task Force List that have an A or B rating.
The American Medical Association created this modifier to allow providers to identify a preventive service for which patient cost sharing does not apply under the Patient Protection and Affordable Care Act, which prohibits patient cost sharing for non-grandfathered plans.
Modifier 33 is appropriate to use with a CPT code that is a diagnostic/treatment service being performed as a preventive service.

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