Modifier 33, preventive service
Some CPT codes can be used to report either a preventive health service (as identified by US Preventive Services Task Force or Priority Health designation per our Provider Manual) or a diagnostic test for treatment or monitoring of a health condition.
Modifier 33 identifies these services as preventive. Use of this modifier allows us to apply and reimburse the appropriate benefits to member claims with the first claim submission.
CPT defines Modifier 33 as:
When the primary purpose of the service is the delivery of an evidence based service in accordance with the US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (Legislative or regulatory), the service may be identified by adding 33 to the procedure. (Current Procedural Terminology, American Medical Association, 2015).
For additional information on our preventive health services, see Preventive care services billing in this manual.
Use Modifier 33 with codes for services that could be either preventive or diagnostic, to identify that the service rendered or ordered was for preventive health purposes.
- Cytopathology, cervical or vaginal - 88141
- Colonoscopy - 45378
- Lipid panel - 80061
- Dual energy X-ray absorptiometry, bone density study - 77080
- Medical nutrition therapy - 97802
When not to use modifier 33
Do not use modifier 33 when the service is already specifically identified as preventive within the definition.
- Periodic comprehensive preventive medicine E&M - 99395
- Screening mammography, bilateral - 77057
- Screening test, pure tone air only - 92551
- Preventive medicine counseling and/or risk factor reduction intervention(s) - 99412
- Prostate cancer screening - G0102
- Anesthesia modifiers
- AT: Active treatment
- GA and GY: Medicare non-coverage notification
- GN, GO & GP: Therapy type
- UD and UA: Treated and released or admitted/transferred (Medicaid only)
- XE, XS, XP, XU: Distinct services
- 22: Unusual procedural services
- 25: Significant service separate from E&M service
- 26 and TC: Professional and technical components
- 33: Preventive service
- 50 & 51: Bilateral and multiple procedures
- 52: Reduced services
- 53: Discontinued procedure
- 54 & 55: Surgical care and post-op care
- 56: Pre-operative management only
- 59: Distinct procedural service
- 62: Two surgeons
- 73 & 74: Discontinued outpatient surgery
- 76 & 77: Repeated procedures, same day
- 78: Unplanned return to operating room
- 80, 81, 82: Assistant at surgery