Fam Pract Manag. 2016 Jul-Aug;23(4):38.
Author disclosure: no relevant financial affiliations disclosed.
When should our office use the new modifier 33?
Modifier 33 was added in response to the Patient Protection and Affordable Care Act provision that requires insurers to cover certain preventive services and immunizations without cost sharing to the patient. When billing for services that could be either preventive or diagnostic (e.g., 45378, Colonoscopy), use modifier 33 to indicate that the code represents a covered preventive service. This ensures that the patient will not be subject to a copayment or deductible. However, if a service is already identified as preventive within the definition, do not use modifier 33 (e.g., 77057, Screening mammography, bilateral).
ICD-10 coding for preventive visits
How should I report ICD-10 codes for preventive visits
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Send questions and comments to firstname.lastname@example.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.
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