Question: I’ve been told by other coders that I can use modifier 33 on preventive services. Is that correct?
Missouri Subscriber
Answer: Yes, you should use modifier 33 (Preventive services) in some cases, depending on your payer.
Modifier 33 notifies your payer that the preventive service was performed and that the patient’s deductible and coinsurance do not apply under the new Patient Protection and Affordable Care Act (PPACA) rules.
The PPACA requires all health care insurance plans to cover preventive services and immunizations without any cost sharing. In other words, the payer must provide first-dollar-coverage for certain specified preventive services.
Downside: According to a Q&A on WPS Medicare’s Web site, Medicare does not recognize modifier 33 (http://www.wpsmedicare.com/j5macpartb/resources/provider_types/awv-faq.shtml).
Reason: Medicare can only pay for preventive services that are specifically legislated and all of these services have their own HCPCS “G” codes to describe them. You can only place modifier 33 on a CPT® code, so modifier 33 isn’t applicable on a Medicare claim anyway.
Some insurers, such as Excellus BlueCross BlueShield, have information regarding modifier 33 on their Web sites. For example, Excellus shares several guidelines for reporting modifier 33, including: