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January 25, 2018


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Medical Coding News Archives

New Modifier for Preventive Services

 
December 6, 2010:

During the November 2011 CPT Symposium, the American Medical Association announced the creation of a new modifier that is not included in the 2011 CPT manual. Modifier 33 Preventive Service, is related to mandated preventive services performed in order to comply with the Patient Protection and Affordable Care Act (see “Increased Access to Preventive Services Under the Affordable Care Act,” July 2010).

An AMA staff member released the following draft:

33 Preventive Service:
When the primary purpose of the service is the delivery of an evidence-based service in accordance with a U.S. 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.

The U.S. Preventive Services Task Force (USPSTF) identifies an A rating as a preventive service where there is a "high certainty that the net benefit is substantial.” It further defines a B rating as a preventive service for which there is a “high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial."

The USPSTF identifies services as having an A or B rating. Many of these screenings also have other specified criteria such as pregnancy, smoking, age, family genetics, and health maintenance. Some of the A or B rating services are bundled into evaluation and management services. Others are identified by a CPT or HCPCS code. Some of the A- and B-rated services identified by a CPT or HCPCS code are listed below:

  • Ultrasound of abdominal aorta
  • Counseling
    • alcohol misuse
    • nutrition
    • tobacco use
  • Screening
    • breast cancer
    • cervical cancer
    • chlamydia
    • lab tests for cholesterol, diabetes, hepatitis B, HIV, and syphilis
    • colorectal cancer
    • infant sickle cell, hypothyroidism, and PKU,
    • osteoporosis
    • pregnancy anemia, bacteriuria, and Rh incompatibility

 

 
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