33 - JF Part A

Preventive Services

Instructions

When the primary purpose of the service is the delivery of an evidence based service in accordance with a 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. For separately reported services specifically identified as preventive, the modifier should not be used.

Correct Use

• Add modifier 33 to the following services to waive patient deductible and coinsurance:
  • Advanced Care Planning (99497 and +99498) when performed on the same day as an Annual Wellness Visit (AWV)
  • Social Determinants of Health Risk Assessment (G0136) when performed on the same day as an Annual Wellness Visit (AWV)
  • Moderate sedation services (G0500, 99153) when provided, and in support of, a screening colonoscopy (G0105 or G0121)

Incorrect Use

• Do not add modifier 33 to codes G0136, 99497 or 99498 if it is not billed on the same claim and date of service as a payable Initial AWV (G0438) or Subsequent AWV (G0439)
• Do not add modifier 33 to any procedure code that is specifically identified as preventive in the code description
• Modifier 33 and modifier PT should not be submitted on the same claim line

Resources

• Advance Care Planning (ACP) Furnished as an Optional Element with an Annual Wellness Visit (AWV) Upon Agreement with the Patient (Change Request (CR) 9271)
• Annual Wellness Visit: Social Determinants of Health Risk Assessment
• Expanding Coverage of Colorectal Cancer Screening (CR 13017)
• Preventive and Screening Services Update - Intensive Behavioral Therapy for Obesity (CR) 8874)