Modifier 33

Does anyone have any information about this modifier? Is it used along with or in place of the new "PT" modifier that Medicare wants us to use when a screening colon turns diagnostic?

re: Modifier 33

The AMA released this modifier effective 01/01/11. It lets the payers know to process specific screenings with no ocopay/co-insurance/deductible to the patient. MCR doesn't recognize modifier 33, but they do use modifier PT for a Coloscopy that started as a Screening and converted over to diagnositc. Anthem and Commercial carriers do utilize modifier 33. The Preventative Services Task Force has rated specific codes (found at the web address listed below) as having an A or B rating.
http://www.uspreventativeservicetaskforce.org/usptf/uspsabrecs.htm.
Each screening has specific criteria to be covered. You must read each one carefully to see if you may be able to use this modifier.

re: Modifier 33

For Medicare screening colonoscopies that become diagnostic or therapeutic, I would continue to use modifier PT. That is how the payer is going to know that even though you are using a CPT® code and not the screening HCPCS colonscopy codes, it was scheduled as a screening. It will make a difference in the patient due portion.

Modifier 33 is going to help commercial insurers know when to apply co-pays and deductibles, and when it should be first dollar coverage. I'll post an article about this, with the AMA instructions about modifier 33, over the weekend. Look for it on Monday.

re: Modifier 33

I stand corrected. I just found an update on the CMS website.Pub 100-04 Medicare Claims Processing Transmittal#2172 Change Request#7344 Appendix M the effective date is 01/01/11 to add modifier 33 to the valid modifier list list.
Pub 100-20 One-Time Notification Transmittal#864 gives a list of which Preventative Services with the CPT® Codes will waive/not waive the patient's portion.