CPT Modifier 33

Description
Preventative Service

Guidelines and Instructions
Submit this modifier when the primary purpose of the service is the delivery of an evidence based service in accordance with a USPSTF A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure.

For separately reported services specifically identified as preventive, the modifier should not be used.

Example: Anesthesia for Screening Colonoscopy
In the event that a screening colonoscopy becomes a diagnostic colonoscopy, the HCPCS 00810 anesthesia claim should be submitted with modifier PT — colorectal cancer screening test, converted to diagnostic test or other procedure. This will trigger the claims processing system to not apply the deductible to the service, but co-insurance will still apply.

Modifier 33 and modifier PT should not be submitted on the same claim line for HCPCS 00810.

Coinsurance and Deductible Effective January 1, 2015, beneficiary coinsurance and deductible does not apply to the following anesthesia claim lines when furnished in conjunction with screening colonoscopy services and when billed with Modifier 33:

00810: Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum

References

• Preventive and Screening Services — Update: Intensive Behavioral Therapy for Obesity, Screening Digital Tomosynthesis Mammography, and Anesthesia Associated with Screening Colonoscopy
• Medicare Wellness Visits
• Medicare Preventive Services