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Third-Party Payor Denial of Modifier -33: Q&A With Jessica Edmiston of National Medical Billing Services

Jessica Edmiston is manager, coding, for National Medical Billing Services.

 

Q: Concerning screening colonoscopies, our ambulatory surgery center is having no problem using the -PT modifier for Medicare but third-party payors are not accepting the -33 modifier. Do you know why this would be happening and what we can do about it?

 

Jessica Edmiston: The 33 modifier became effective Jan. 1 but wasn't actually published until April 1.

 

Sometimes there can be a delay in carriers updating their systems to support new CPT codes and modifiers. We would recommend working with the provider representative for all carriers and finding out if their system has been updated to support the new modifier.

 

If their system has not been updated, try to find out when the system will be updated and what modifier should be used until the update occurs.

 

Note: The description for modifier -33 is as follows: 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 appending modifier 33, Preventive Service, to the service. For separately reported services specifically identified as preventive, the modifier should not be used.

Modifier -33 is to be reported for all carriers other than Medicare and is used in similar circumstances as the -PT modifier for Medicare.

 

Learn more about National Medical Billing Services.

 

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