Modifier 33?

Having problems being paid for preventive testing?  Medicare anticipated such problems when it added modifier 33 as a HCPCS II code to be effective January 1, 2011.

Modifier 33 should be used in addition to an allowed preventive diagnosis on procedures that are not preventive BY DEFINITION.  Thus, you would add a modifier 33 for Cardiovascular Screening Tests; but not to an annual wellness exam.

Although it excludes some of the newly added preventive services, an excellent resource is Medicare's Quick Reference Card to Preventive Services. 

Using Cardiovascular Screening Tests as an example, you would code:

Lipid Panel as 80061-33

Cholesterol as 82465-33

Lipoprotein as 83718-33, and 

Triglycerides as 84478-33.

The diagnoses would be one or more of the following codes:  V81.0, V81.1, V81.2.

Note that this will be paid as preventive only once every five years; so keep good records.

Follow these guidelines and you WILL get these items paid without your patient being responsible for any copay or deductible.