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Is the PT modifier only for medicare patients? A patient called today and said BC/BS told her that she would need to tell our office when we bill her for her colonoscopy that we need to use the PT modifier. Is this correct?
PT is a Medicare modifier and should be used when billing to Medicare. i would use modifer -33 when sending to BCBS or look at the policy on the web site on how they want it to be billed.
The PT is for Medicare. The 33 is for other commercial. However BCBS claims if I was using the 33 is is not recognized so after contacting BCBS they indicated that they need no modifier as the screening diagnosis will tell that the service is a preventative service
There is information available in regards to this. Specifically this is bcbs of GA but you should be able to find something like this or contact your provider reps.
I recently started adding modifier -PT and -33 to BCBS cscopes. So far all have processed no problems.
BCBS of Georgia recognizes the PT modifier for colonoscopy, flex sig, etc. We have been using it successfully. However, BCBS plans from other states do not always use it.