Wiki Modifier 33 with Essure

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milissalove092005

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We have a rep w/ Essure who has given us a packet which shows to bill modifier 33 with the Essure (58565).
Some one please adivse me. I was under the impression Modifier 33 is for preventive services. Is an Essure considered a preventive service now?

Additionally, from my understanding of modifier 33 was created to allow providers to notify insurance payers that the service was preventive under applicable laws and patient cost-sharing does not apply. It indicates when it is appropriate to WAIVE the deductible associated with copay/coinsurance.

please enlighten me on Modifier 33 :confused:
 
modifier 33

I haven't heard that from our Essure rep, the modifier we do use is mod 50 for bilateral procedure. No denials for that.
 
Modifier 33

This is something new, I believe effective under the affordable care act this is now considered preventative. Here is the copy paste from essure website
AFFoRDAbLE CARE ACT (ACA) AND CoMMERCIAL
INSURANCE
Through the Affordable Care Act, Essure? may be available to most patients at
no cost
The ACA is reducing financial barriers by requiring most insurance plans to cover women?s birth
control and preventive care services without any co-pays, deductibles, or out-of-pocket expenses
when their plan renews.1
Some individual plans may have exemptions, and the availability of the benefits depends on the policy
renewal date. When verifying patient benefits, it is important to specifically inquire as to whether the
Essure Hysteroscopic Sterilization Procedure (CPT 58565) and the Essure Confirmation Test (58340
and 74740) are covered at NO COST SHARE to the patient as part of the preventive services.
Although most insurers must comply with this new legislation, some plans have limitations or are
exempt due to religious affiliation or grandfathered status.1
How to verify insurance coverage
It is important to verify each patient?s benefits to determine coverage and billing requirements prior
to scheduling an Essure placement procedure.
Office personnel may also verify a patient?s Essure coverage by contacting the patient?s health
insurance provider directly. The phone number can usually be found on the member?s insurance card.
Be sure to verify coverage and payment levels for both the Essure procedure and Essure Confirmation Test.
Modifiers
In some cases, adding a modifier to the code may be necessary. Because Essure is considered a
preventive service, add a modifier (33) to the procedure code (58565) and Essure Confirmation Test
code (58340).
CPT Modifier 33 is applicable for the identification of preventive services without cost sharing in 4
categories. Essure and the HSG fall under category 4: Preventive care and screenings provided for
women (not included in the US Preventive Services Task Force A or B rating) in the comprehensive
guidelines supported by the Health Resources and Services Administration.
Note: Not all commercial payers will require the use of Modifier 33. Some will automatically process
the Essure procedure and the Essure Confirmation Test without patient cost sharing.
 
Reimbursement for Essure with Modifier 33

If you billed an in office Essure with modifier 33, does that reduce reimbursement? If adding the modifier to cover no cost share to the patient, I still need to cover cost of device & physician reimbursement. Has anyone used this modifier and had any change in reimbursement?
Any suggestions will help!
 
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