Can I use Modifier 33 on CPT 99385, 99397 or 99402, 99403

Question: Can I use Modifier 33 on CPT 99397 or 99402?

Answer: NO. If you are going to look at the description of Modifier 33 – it is for “Preventive Service”. These 2 codes 99397 and 99402 are already “inherently” preventive service by nature.

And since the 99402 is in the “Preventive Medicine Service” – then you CANNOT use the modifier 33 for codes that are already “inherently” Preventive. Append your Modifier 33 to codes (procedures) that turned out to be preventive… one very good example is also your 80061. Always make sure you have strong documentations and always based on Medical Necessity.

Modifier 33 was created by the AMA and effective January 1, 2011, in response to a need for payers and health plans to identify services that are NOT inherently preventive but provided as a result of preventive service. Modifier 33 is THEREFORE used to identify to a payer that the copayment and deductible for a preventive services under the Patient Protection and Affordable Care Act PPACA; it requires all insurance carriers to cover preventive service and immunizations without cost-sharing.

Here’s a guideline from the American Medical Association who owns CPT. AMA Mod 33 new-cpt-modifier-for-preventive-services (in PDF file)

*** You can append Modifier 25 on the Problem-Focused Code 99213-99214 / 99203-99205 if the encounter is due to patient’s illness or is “problem-focused.

Related Article on “When to Use Modifier 33”

When to Use Modifier 33

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