Iâ€™ll talk about Modifier 33 first. The short answer to when you are to use Modifier 33 is on "preventive services". The long answer is in Michellde's post from 1-3-11. I've included an excerpt at the bottom of this page.
Insurance carriers have known about this for awhile because they had to identify preventive services that were included in the mandate. I have worked with a group of carriers to identify how they were going to do that. My experience is that carriers have identified these services by CPT, HCPCS, and/or ICD codes or a combination of these. So they don't "need" the Modifier 33 to identify preventive services that have no cost sharing.
From a coding perspective, we should use Modifier 33 when applicable.
OK - now Modifier PT. First, although Modifiers 33 and PT seem to be connected, they identify different things. Stick with me here.
Modifier 33 identifies screening/preventive services. Modifier PT is used to identify when a "screening/preventive" services turns into a diagnostic/theraputic service.
The most common example for Modifier PT would be when a person has a screening colonoscopy and a polyp is found. If the polyp is removed, the "screening" turns into a therapeutic procedure. In this situation, Modifier PT is used to identify that the procedure started as a screening but ended up a therapeutic procedure. Medicare will waive the deductible in this situation. This is not part of the USPSTF mandate.
CPT modifier 33 is applicable for the identification of preventive services without cost-sharing in these four categories:
1.Services rated â€śAâ€ť or â€śBâ€ť by the US Preventive Services Task Force (USPSTF) (see Table 1) as posted annually on the Agency for Healthcare Research and Qualityâ€™s Web site: http://www.uspreventiveservicestaskf...spsabrecs.htm;
2.Immunizations for routine use in children, adolescents, and adults as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;
3.Preventive care and screenings for children as recommended by Bright Futures (American Academy of Pediatrics) and Newborn Testing (American College of Medical Genetics) as supported by the Health Resources and Services Administration; and
4.Preventive care and screenings provided for women (not included in the Task Force recommendations) in the comprehensive guidelines supported by the Health Resources and Services Administration.
US Preventive Services Task Force. USPSTF A and B Recommendations. August 2010. Available at: http://www.uspreventiveservicestaskf...uspsabrecs.htm.
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