Modifier 33 Description, Examples, and Usage Guidelines

Medical coding is intricate, and the concept of modifiers just makes things more challenging for physicians trying to handle this process in-house without hiring certified professional coders (CPCs). Things become more complicated when you find out that even modifiers have different categories. In this guide, we will discuss a CPT modifier that you can only use while billing commercial payers. Interesting, right?

So, if you are having trouble understanding where to use the CPT modifier 33, this guide covers everything you need to know to ensure its appropriate usage.

Table Of Contents

What is Modifier 33?
Modifier 33 – Examples
Accurate Usage Guidelines for Modifier 33
Summary

What is Modifier 33?

This modifier identifies that the primary purpose of the rendered procedure is to deliver evidence-based service in compliance with the US Preventive Services Task Force (USPSTF). These services may have an A or B rating, denoting high certainty of substantial net benefit or high certainty of moderate-to-substantial net benefit, respectively.

Note that you can only use this modifier to report services to commercial payers.

Modifier 33 – Examples

Before discussing the examples, let’s first establish that the patients in all situations are privately insured to make things easier.

Cholesterol Preventive Screening

Consider a patient who encounters a healthcare provider for a routine checkup. The physician requests a lipid panel to assess the patient’s cholesterol levels.

Thus, modifier 33 will be appended with CPT code 80061 to alert the payer that the lipid panel is performed as a preventive service.

Depression Screening

When a primary care physician uses a standardized screening tool to evaluate the patient for depression, you may report CPT 96127 with a modifier 33 to signal the payer that it is being billed as a preventive service.

Colonoscopy

Assume another scenario where a patient undergoes a colonoscopy as a preventive screening, but during the procedure, the physician finds polyps and removes them. Thus, the provider may report procedural code 45385 with CPT modifier 33 to indicate that it was initially a preventive service.

Accurate Usage Guidelines for Modifier 33

Here are some guidelines to ensure the appropriate application of CPT modifier 33:

Apply to Only Commercial Payers

You can only use CPT modifier 33 for commercial payers because the Centers for Medicare and Medicaid Services (CMS) has not issued any guidelines for its usage. Simply put, Medicare and Medicaid do not recognize it. Thus, if you submit a claim with 33 to Medicare, you will receive it with a Medicare Outpatient Adjudication (MOA) code, MA130. This code specifies that the claim has incomplete or missing information. As a result, it cannot be processed.

Understand Which Services Are Covered

Remember that only some selective immunizations and preventive services are covered under the ACA. Thus, before you append the CPT modifier 33, we advise you to determine whether the rendered procedure falls under one of the following categories:

All screenings and preventive care for children that the Health Resources and Services Administration (HRSA) supports and the American College of Medical Genetics, Newborn Testing, and American Academy of Pediatrics, Bright Futures recommends are fully reimbursable if you add this modifier.
You can use this modifier with any service the USPSTF has rated either A or B. A identifies substantial net benefit with high certainty, while B identifies moderate to substantial net benefit with high certainty.
You may also append modifier 33 with routine immunizations for adults, adolescents, and children as advised by the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices.
This modifier is also applicable when billing preventive care and screenings for women covered in the comprehensive guidelines supported by HRSA. However, these procedures are not included in HRSA.

Preventive Turned Diagnostic Service

Another rule that allows you to append modifier 33 is when a preventive service converts into a diagnostic or therapeutic service.

Apply to All Eligible Services

If a healthcare provider renders multiple preventive services to the same privately insured patient on the same day, then you should apply this modifier to each eligible service to ensure accurate reimbursements.

Designated Preventive Services

You cannot append this to designated preventive services, such as HCPCS Level II G codes. Besides, you should use HCPCS Level II codes instead of G codes for these services without appending the modifier 33 if the patient is privately insured.

For instance, if you performed screening mammography for a non-Medicare patient, you will use CPT code 77057 without 33. However, use G0202 to report the same service to Medicare, also without appending this modifier since the payer does not recognize it.

Summary

This guide discussed a complicated CPT modifier. Many providers have trouble gauging where to append it and whether or not to append it while billing Medicare. We tried to shed light on all aspects while writing this guide.

Let’s quickly recap what we discussed. We shared the modifier 33’s description, scenarios where you may append it, and guidelines for its appropriate usage. We understand that understanding the concept of modifiers is not a piece of cake. Thus, we tailor medical coding services to help providers experience error-free coding and seamless cash flow. If you are having trouble handling billing in-house, why not consider outsourcing?

Frequently Asked Questions

When to use modifier 33 for colonoscopy?

If a healthcare provider, while performing a screening colonoscopy, finds and removes a polyp with a snare on a privately insured patient, you should append 33 with code 45385.

Does Medicare accept modifier 33?

No, you can only append this modifier with commercial payers. If you submit a claim with CPT modifier 33 to Medicare, it will be returned with MA130, i.e., a Medicare Outpatient Adjudication (MOA) code. It means the claim has invalid or missing information, which makes it unprocessable.

Can I append modifier 33 to CPT 71046?

Yes, you can append modifier 33 to CPT code 71046 if the chest X-ray was performed for preventive reasons.

Can I use a 33 modifier on CPT 45385?

Yes, you can use the 33 modifier with CPT code 45385 for reporting screening colonoscopy to a commercial payer.

Can you use modifier 33 with 99215?

You cannot use this modifier with CPT code 99215 because it is an evaluation and management (E/M) code.

Can you use modifier 33 with G0438?

No, you should not use this modifier with designated preventive services such as HCPCS Level II G codes.

Is modifier 33 a pricing modifier?

It is a CPT modifier that represents covered preventive services under USPSTF guidelines. It warrants complete reimbursements from payers for services without patient costs.

What is the difference between modifier PT and 33?

Modifier 33 widely applies to any ACA-preventive service, under USPSTF guidelines, billed to a commercial insurance payer. Contrarily, modifier PT is specific to colorectal screenings converted to therapeutic or diagnostic services.