Page 2 of 4 FirstFirst 1234 LastLast
Results 11 to 20 of 34

Modifier 33 - CPT Symposium

  1. #11
    Athens, OH
    Medical Coding Books
    I thought that the modifier PT was to be attached to a preventative colonoscopy that then turned diagnostic. This is the first I have heard of the 33 modifier?
    RBoggs CMA, CGSC **Bloom where you are planted**

  2. #12
    Are all Medicare carriers expecting use of this modifier? Seems as if there would be more education...

  3. #13
    Columbia, MO
    PT is for Medicare and 33 is for all other payers

    Debra A. Mitchell, MSPH, CPC-H

  4. Default Looking for Medicare policy
    I have read the AMA documentation on the new modifier, but I can't find anything on CMS or Palmetto.gba (our MAC) on the use of this modifier.

    Does anyone have a link to the Medicare policy on this?


  5. Default 33 as it related to V12.72
    Does anyone have any documentation if V12.72 is considered preventive under the colorectal screening under the U.S. Task Force. I'm not sure if we do a colonoscopy for V12.72 and find nothing, if we should use modifier 33?

    Any thoughts
    M. Klaubauf, CPC

  6. Default
    What about modifier "PT" I thought this was a new modifier that was added to colonoscopies when they turned from screening do diagnostic? How is this different from "33"

  7. Default
    Does anyone know about modifier PT? that was suppose to be new and serve the same purpose.

  8. #18
    It was noted above that the PT modifier is for Medicare and 33 for all other payers. Is there documentation to support this? I did find the following on the ASC Review website:

    A new HCPCS modifier takes effect Jan. 1, 2011, for use in cases where a screening colonoscopy or screening flexible sigmoidoscopy was planned, but clinical findings leads to a diagnostic colonoscopy, according to the Ambulatory Surgery Foundation.

    Modifier –PT will "prompt the claims processing system to waive the deductible for ALL surgical services on the same date of service as the diagnostic service," according to the ASF. "Unlike the additional waiver of copayments and coinsurance for straight screening services allowed by the Patient Protection and Accountable Care Act, if the planned screening service becomes a diagnostic service, only the deductible is waived."

    The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

  9. #19
    Columbia, MO
    from the december CPT assistant:
    In response to this PPACA requirement, CPT modifier 33 has been created to allow providers to identify to insurance payers and providers that the service was preventive under applicable laws, and that patient cost-sharing does not apply. This modifier assists in the identification of
    preventive services in payer-processing-systems to indicate where it is appropriate to waive the deductible associated with copay or coinsurance and may be used when a service was initiated as a preventive service, which then resulted in a conversion to a therapeutic service. The most notable
    example of this is screening colonoscopy (code 45378), which results in a polypectomy (code 45383).
    Note that Medicare has created HCPCS II codes for some of these preventive medicine services.
    CPT modifier 33 is effective after January 1, 2011, and should be appended to codes representing the preventive services, unless the service is inherently preventive, eg, a screening mammography
    or immunization recognized by the Advisory Committee on Immunization Practices (ACIP). If multiple
    preventive medicine services are provided on the same day, the modifier is appended to the codes for each preventive service rendered on that day.

    Debra A. Mitchell, MSPH, CPC-H

  10. #20
    Ok, slowly but slowly putting this together. I was surprised that modifier 33 would be required but there has been little education (other than here on the forum!). The following explains:
    PPACA specifies that group health plans or insurance coverage existing on the date of enactment (March 23, 2010) are not required to comply with certain plan requirements under PPACA. These include, for example, the requirement for coverage of preventive care at no cost to the participant or insured. As explained in the preamble to the IFR, however, PPACA does not address at what point changes to such group health plan or health insurance coverage are significant enough to cause the plan or health insurance coverage to cease to be a grandfathered plan, leaving that question to regulatory guidance.

    The interim final regulations (IFR) set out the specific requirements that a group health plan or insurance carrier must comply with in order to maintain status as a “grandfathered” plans. In general, the rules provide that grandfather plans will lose their status if “they choose to make significant changes that reduce benefits or increase costs to consumers”,

Page 2 of 4 FirstFirst 1234 LastLast

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 01:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 12:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 07:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 12:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 03:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.