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Thread: PT Modifier - CMS

  1. #1

    Default PT Modifier - CMS

    AAPC: Back to School
    Does anyone have any information on the use of the PT modifier for screening procedures (GI) as of 1/1/11. I am unable to locate anything on CMS and a lot of our commercial payers & Medicare managed care plans know nothing about this modifier. Any help is appreciated. Thanks,

  2. #2


    MLN Matters Articles MM7012 and CR TRansmittal R739OTN


    PT Modifier information found on page 14. I interpreted to mean that any colonoscopy, flex sig, etc that starts out as a screening (EX: G0121, G0105) but turns into a procedure (EX: 45385, 45384) should be coded with the CPT code with modifier PT to show that it started out as screening. In this scenario the patient's deductible will still be waived, but coins may now apply.

    Hope this helps!

    Anna Barnes, CPC, CEMC, CGSCS

  3. #3
    Join Date
    Apr 2007
    Redding, CA


    This is the information I have found, this is the Northern California MCR carrier, but the info is system-wide for mcr. http://www.palmettogba.com/palmetto/...fier%20PT?open

  4. #4
    Join Date
    Apr 2007
    Athens, OH


    I just read about another new modifier, 33. In the article it says that the example of using 33 would be in a screening colonoscopy that becomes diagnostic. I am confused about these as they seem to be saying the same thing but the 33 is for a broad range of preventatives and PT is only for colonoscopies.....is that right??
    RBoggs CMA, CGSC **Bloom where you are planted**

  5. #5

    Default ?? modifier-33

    I am equally confused. i have been able to find info on the PT modifier thanks to the links that have been provided. But I am not able to find anything on the 33. Also, the mln matter had mentioned that a pre-exam visit will also be covered at 100%. would we need a G-code or a modifier for this visit ?

  6. #6

    Default New CPT modifier for Preventive Services

    Check CPT Assistant December 2010/Volume 20 Issue 12
    The article is named as above and discusses 33 modifier.

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