Modifier 33 Preventive services is effective retroactively Jan. 1, 2011, according to CMS. The modifier can be used with CPT and HCPCS Level II prevention codes but not with codes for services that are inherently preventive.
The American Medical Association developed the modifier in order to meet a requirement of the Patient Protection and Affordable Care Act that mandates healthcare insurance plans cover preventive services and immunization without any cost-sharing. Modifier 33 was created to allow providers to demonstrate to payors that the service was preventive under applicable laws with no patient cost-sharing.
The AMA’s example is a screening colonoscopy (45378) resulting in a polypectomy (45383). The official AMA description of modifier 33 can be found here.
Read the AAPC report on modifier 33.
Read more on coding:
–MedPAC Recommends 0.5% Increase for Surgery Centers, 1% for Physicians
–AMA Updates CPT 2011 Corrections Document
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