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Use of Modifiers 33 and PT

Carol Posted Tue 21st of June, 2011 13:34:44 PM

Since these modifiers are not currently listed in the modifier descriptions, is anyone using them besides myself? I place the modifier 33 after a Screening Colonoscopy turned into a therapeutic procedure for commercials and PT for Medicare patients. I read that this will prevent the deductible from being applied in accordance with Health Care Reform. Is anyone else doing this?

SuperCoder Answered Tue 21st of June, 2011 18:17:53 PM

New CPT Modifier for Preventive Services (33): The implementation of health care reform regulations has begun with a significant change involving preventive services. The Patient Protection and Affordable Care Act (PPACA) requires all health care insurance plans to begin covering preventive services and immunizations without any cost-sharing, i.e., they must provide first-dollar-coverage for specified preventive services. The timing of implementing these changes is dependent on when health insurance plans renew or change. The regulations specify that plans cannot impose cost-sharing requirements, such as co-pays, coinsurance or deductibles with respect to specified preventive services, when preventive services are billed separately. When these services are part of an office visit, the visit may not require cost-sharing if the primary reason for the visit is to receive preventive services. However, cost-sharing is permitted when the office visit and covered preventive services are billed separately and the primary purpose of the visit is not delivery of the covered preventive services.

Details of Modifiers 33 and PT can be referred to:
http://www.ama-assn.org/ama1/pub/upload/mm/362/new-cpt-modifier-for-preventiveservices.pdf.
www.cms.gov/MLNMattersArticles/downloads/MM7012.pdf.

Carol Posted Tue 21st of June, 2011 20:10:15 PM

Thank you for your prompt reply. I tried to download the AMA information but I think there might be a typo because it would not go through. Could you please check it again and resent it to me.

Thank You

SuperCoder Answered Tue 21st of June, 2011 20:33:05 PM

http://www.ama-assn.org/ama1/pub/upload/mm/362/new-cpt-modifier-for-preventive-services.pdf

SuperCoder Answered Tue 21st of June, 2011 20:33:52 PM

The summary of all these guidelines are here:
https://www.excellusbcbs.com/wps/wcm/connect/0e61b680441ec175af7abffecdbcf292/HCR+Modifiers+33+and+PT+Notice+FINAL.pdf?MOD=AJPERES&CACHEID=0e61b680441ec175af7abffecdbcf292

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