Does 99497 need a 33 modifier?
Asked by: Mrs. Pink Fahey DVM | Last update: September 11, 2025Score: 4.5/5 (11 votes)
What modifier should be used with 99497?
If advance care planning is provided as a Medicare preventive service on the same date as an annual wellness visit (G0438 or G0439), append modifier 33 to 99497 for the first 30 minutes and, if reported, 99498 for an additional 30 minutes.
When should modifier 33 be used?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
How do I bill my CPT code 99497?
Code 99497 can be billed for the first 30 minutes of the advance care planning (ACP) conversation. For an ACP conversation of less than 16 minutes, CMS suggests considering billing a different evaluation and management (E/M) service such as an office visit.
Why is Medicare denying 99497?
Billing improperly for an add-on code without billing for the primary code (99497) is a common reason for claims denials. Primary code 99497 can be billed for the first 30 minutes of the conversation. But if the conversation is less than 16 minutes then a different code (e.g., E/M code) must be used.
When To Use A Modifier in Medical Coding
Does 99497 need modifier 33?
Yes. Advance care planning is a preventive service only when provided in conjunction with an annual wellness visit and reported with modifier 33 attached to the advance care planning code (e.g., 99497-33).
Can you bill 99497 with modifier 25?
Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) must be appended to CPT code 99497.
Does G0439 need modifier 25?
Along with HCPCS G0438 or HCPCS G0439, CPT code modifier -25 must be appended to the medically necessary E&M service. CPT guidelines define the -25 modifier as "Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service."
Can 99497 and 96372 be billed together?
Separate reimbursement will not be allowed for CPT code 96372 when billed with an Evaluation and Management (E/M) Service (CPT code 99201-99499) by the same rendering provider on the same service date.
Which advance beneficiary modifier may be reported in addition to modifier?
Use the GX modifier to report a voluntary ABN was issued for a service that Medicare never covers because it is statutorily excluded or is not a Medicare benefit. Line items submitted as non-covered will be denied as beneficiary liable. The GX modifier can beused in combination with the GY modifier, when applicable.
How do you know if a code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
What is CPT 96127 with modifier 33?
When a primary care physician uses a standardized screening tool to evaluate the patient for depression, you may report CPT 96127 with a modifier 33 to signal the payer that it is being billed as a preventive service.
How to bill a colonoscopy with poor prep?
The failed procedure is billed and paid using CPT® code 45378, HCPCS code G0105 or G0121, or CPT® code 44388, if attempting to perform the colonoscopy through an existing stoma. Modifier “-53” (discontinued procedure) must be appended to any procedure code submitted when billing for a failed colonoscopy attempt.
What is the 33 modifier?
By appending modifier 33, the provider alerts the insurer that a covered preventive service was provided, and that patient cost-sharing does not apply.
Can you bill an 99497 with an AWV?
Yes, CPT 99497 and 99498 can be billed separately as long as minimum time requirements are met. Use modifier -33 to avoid co-pay and deductible. Yes, CPT 99497 and 99498 can be billed separately as long as minimum time requirements are met. Use modifier -33 to avoid co-pay and deductible.
What is included in advance care planning?
What is advance care planning? Advance care planning involves discussing and preparing for future decisions about your medical care if you become seriously ill or unable to communicate your wishes.
How to bill 99497?
CPT® codes 99497 and 99498 are time based codes (a base code and an add-on code). Practitioners should consult CPT® provisions regarding minimum time required to report timed services. Use CPT® code 99497 for the first 16 to 30 minutes. Use CPT® code 99498 for each additional 30 minutes.
Can you bill 99497 by itself?
Yes. Code 99497 must always be billed for the first 30 minute period of the ACP discussion. If the conversation lasts longer, 99498 (the add-on code) may be billed for each additional 30 minutes of the ACP discussion, with no limit.
What is the 59 modifier used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
When should a 25 modifier be used?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
Can you bill an AWV and E&M together?
The CMS website states “When you provide an annual wellness visit and a significant, separately identifiable, medically necessary Evaluation and Management (E/M) service, Medicare may pay the additional service. Report the additional CPT code with Modifier-25.
Can modifier 25 be used with G0463?
You may need a -25 modifier on G0463 if the other services performed have a status indicator of S, T, or V.
What is the ICD 10 code for advance care planning?
99497, Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.
Can modifier 25 be used with preventive services?
Beginning January 1, 2025, Medicare will allow payment for G2211 when the base E/M services is appended with modifier 25 and provided on the same date as an annual wellness visit, initial preventive physical examination, vaccine or Medicare preventive service.
Can you bill 90833 and 99214 together?
It is acceptable to bill CPT codes 99201-99215 and 90833 or 90836 or 90838. Behavioral health assessment/evaluation and psychotherapy Do not bill CPT codes 90791-90792 and 90832- 90838. These codes are not billable on the same date to the same member by the same provider.