Some CPT codes can be used to report either a preventive health service (as identified by US Preventive Services Task Force or Priority Health designation per our Provider Manual) or a diagnostic test for treatment or monitoring of a health condition.

Modifier 33 identifies these services as preventive. Use of this modifier allows us to apply and reimburse the appropriate benefits to member claims with the first claim submission.

Definition

CPT defines Modifier 33 as:

When the primary purpose of the service is the delivery of an evidence based service in accordance with the US Preventive Services Task Force 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. (Current Procedural Terminology, American Medical Association, 2015).

For additional information on our preventive health services, see Preventive care services billing in this manual.

Examples

Use Modifier 33 with codes for services that could be either preventive or diagnostic, to identify that the service rendered or ordered was for preventive health purposes.

• Cytopathology, cervical or vaginal - 88141
• Colonoscopy - 45378
• Lipid panel - 80061
• Dual energy X-ray absorptiometry, bone density study - 77080
• Medical nutrition therapy - 97802

When not to use modifier 33

Do not use modifier 33 when the service is already specifically identified as preventive within the definition.

Examples:

• Periodic comprehensive preventive medicine E&M - 99395
• Screening mammography, bilateral - 77067
• Screening test, pure tone air only - 92551
• Preventive medicine counseling and/or risk factor reduction intervention(s) - 99412
• Prostate cancer screening - G0102

When billing for 99497 or 99498 on the same claim and date of service as a payable Initial AWV (G0438) or Subsequent AWV (G0439), see our Advance care planning billing policy for modifier 33 use.

Modifier 33 and modifier PT shouldn't be submitted on the same claim line.

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