What is the modifier 33 for preventive services?
Asked by: Mrs. Daphnee Boehm | Last update: November 19, 2025Score: 4.3/5 (69 votes)
What is the preventive modifier 33?
Modifier 33 should be used when the primary purpose of the service is the delivery of an evidence-based service in accordance with the guidelines provided by one of the ACA-designated organizations, including an A or B recommendation from the USPSTF.
What is the difference between PT and 33 modifier?
While modifier PT is specific to colorectal screenings converted to diagnostic or therapeutic services, modifier 33 broadly applies to any ACA-designated preventive service with a commercial payer.
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 code a preventive visit?
Preventive visit codes 99381-99397 include “counseling/anticipatory guidance/risk factor reduction interventions,” according to CPT. However, when such counseling is provided as part of a separate problem-oriented encounter, it may be billed using preventive medicine codes 99401-99409.
When To Use A Modifier in Medical Coding
Does 99497 need a 33 modifier?
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 an office visit with a preventive visit?
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
Can you bill 96127 with a preventive visit?
Billing Guidelines for 96127
This code is commonly used in the context of preventive medicine services and can also be reported with other E/M services such as acute illness or follow-up office visits.
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.
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.
Is a colonoscopy preventive or diagnostic?
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.
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.
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 are preventive care services?
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
Can I use modifier 25 on a preventive visit?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
Who can bill for advance care planning?
Health Care Professionals Who May Furnish and Bill ACP:
Physicians (any specialty) Clinical nurse specialist (CNS) Nurse practitioners (NPs) Physician assistants (PAs)
When should modifier 33 be used?
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. Use when the USPSTF has given the service an A or B rating.
Why is a diagnostic colonoscopy not covered by insurance?
Soon after the ACA became law, some insurance companies considered a colonoscopy to no longer be just a “screening” test if a polyp was removed during the procedure. It would then be a “diagnostic” test, and would therefore be subject to co-pays and deductibles.
What if cologuard test is positive but no symptoms?
If your Cologuard test is positive and you are not experiencing symptoms, a colonoscopy is recommended to rule out cancer; many patients with early‐stage colon cancer have no symptoms and are diagnosed through screening.
How do you bill preventive care?
CPT® codes 99381-99397 are used for comprehensive preventive evaluations that are age-specific, beginning with infancy and ranging through patients 65 years and older, for both new and established patients.
Does 96127 require a modifier?
Which modifiers should I use when billing 96127? When 96127 is billed with an E&M code, the E&M code should be billed first with a modifier 25. 96127 should be billed last with a modifier 59.
Can you bill prolonged services with preventive care?
Prolonged Services Codes for Medicare Preventive Medicine Services: G0513, G0514. There are HCPCS prolonged services codes to be used with Medicare preventive services reported based on time. CMS allows these prolonged care codes to be used with wellness visits.
Why did my insurance not cover my doctor visit?
In some cases, the service simply isn't covered by the plan. In other cases, necessary prior authorization wasn't obtained, the provider wasn't in-network, or the claim was coded incorrectly.
Can you bill 99213 and 99396 together?
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
What is the difference between preventive visit and office visit?
The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan covers 100% of a preventive visit when you see a doctor in your plan network. * The purpose of an office visit is to discuss or get treated for a specific health concern or condition.