What is mod 33?
Asked by: Dr. Marilou Larkin | Last update: September 10, 2025Score: 5/5 (4 votes)
What is a modifier 33 used for?
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.
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.
What is the 33 modifier for BCBS?
Appending modifier 33 to a procedure code indicates that the service is a preventive service and one that waives a patient's cost share on the service.
Does medi cal accept modifier 33?
Modifier 33 may be used. Hepatitis C virus infection screening: adults 86803 86804 99384 thru 99387 99394 thru 99397 G0472 Modifier 33 may be used. For all of the HIV laboratory codes, there is no diagnosis code restriction. Modifier 33 may be used.
MOD || Superhit Nepali Serial || Episode 33
What does mod 33 mean?
Modifier 33 is a CPT® modifier used to identify medical care whose primary purpose is delivery of an evidence based service, based on recommendations from the US Preventive Services Task Force.
Does medical pay for colonoscopy?
Federal law. The Affordable Care Act (ACA) requires both private insurers and Medicare to cover the costs of colorectal cancer screening tests, because these tests are recommended by the United States Preventive Services Task Force (USPSTF).
What is the modifier 33 with 99497?
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 a dermatologist bill for preventive care?
It would NOT be appropriate for a dermatologist to report a code from the Preventive Medicine range (CPT 99381-99397) because a dermatologist is a specialist.
What is the modifier 25 for Medi Cal?
E&M service by the same physician or other qualified health care professional on the same day of the procedure or other service Family PACT providers must use modifier 25 to bill an E&M code with E&C services for the same date of service.
What is CPT 45378 with modifier 33?
CPT Code 45378 is the appropriate code for screening colonoscopies. Modifier 33 should be added to indicate that it is a preventive service. Colonoscopies with polyp removal may require additional CPT codes. Understanding the coding guidelines and documentation requirements is crucial for accurate billing.
Does insurance pay for 96127?
CPT Code 96127 is a generic mental health screening code that is covered by most major insurances. It is designed to pay for the evenly applied screening of a large patient population to uncover underlying mental health conditions.
How often does Medi Cal cover pap smears?
Pelvic exam
Medicare covers these screening tests once every 24 months in most cases. If you're at high risk for cervical or vaginal cancer, or if you're of child-bearing age and had an abnormal Pap test in the past 36 months, Medicare covers these screening tests once every 12 months.
How do you know if a CPT 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 a diagnostic colonoscopy?
Diagnostic colonoscopies, also referred to as follow-up or surveillance colonoscopies, are different from screening colonoscopies since such procedures are provided when there is a greater probability of cancer development or if there is evidence that colorectal cancer might be present.
What needs to be documented for a preventive visit?
- A comprehensive history and physical exam findings;
- A description of the status of chronic, stable problems that are not “significant enough to require additional work,” according to CPT;
- Notes concerning the management of minor problems that do not require additional work;
When should modifier 33 be used?
Modifier 33 is used to tell the payer to process the service without a patient due balance, because it was a preventive service with an A or B rating from the USPSTF. Not all commercial patients will have this first-dollar coverage, but many with group health insurance plans will.
Is a dermatology skin check considered preventive care?
Answer: The visit to the dermatologist is not considered preventive care.
What is not covered under preventive care?
What's not considered preventive care? There are times when certain tests and screenings aren't considered preventive care. Things like diagnostic care, bloodwork and sexually transmitted infection (STI) testing may or may not be considered preventive.
What is modifier 32 used for?
Lay Term. Append modifier 32 to a code to show that a third party mandated that the provider perform the service.
What is the CPT code for annual wellness visit?
AWV Coding. The CPT codes for Annual Wellness Visits are G0438 for the initial visit and G0439 for subsequent visits.
Can 99497 be billed as telehealth?
Billing Telephone Encounters
Therefore, Medicare will cover certain additional codes – including advance care planning 99497 and 99498 – fully when conducted by telephone (audio only). Telephone evaluation and management (CPT codes 99441-99443) is also covered, but at the telephone encounter rates.
What is the cheapest way to get a colonoscopy?
Ambulatory surgery centers (ASCs) often charge less than half of what hospitals charge for colonoscopy procedures. Many ASCs have a patient payment estimator to help you figure out how much you'll pay for your colonoscopy.
Why would a colonoscopy not be covered by insurance?
If your doctor removes a polyp during the test, it becomes a DIAGNOSTIC COLONOSCOPY. This means your insurance may not cover the cost. Your care team will let you know after if they find any polyps.
How often should I have a colonoscopy if polyps are found?
If there are 1-2 polyps <1 cm in size (~1/2 inch), then another colonoscopy in 5 years is appropriate. Colonoscopy at 3 years is recommended for patients with 3-4 polyps <1 cm in size or one polyp >1 cm. If there are 5 or more small or 3 or more larger polyps, then follow-up in one year is recommended.