Laboratory Question for the Week of January 24, 2022

Question:

What is modifier 33? Is it applicable for testing?

Answer:

In response to The Patient Protection and Affordable Care Act (PPACA), Modifier 33 was released by the AMA and became effective for billings with a date of service of January 1, 2011. Modifier 33 communicates to a payer that the service or test being billed is preventive under pertinent laws and indicates that patient cost-sharing is not applicable. For separately reported services that are specifically identified as preventive, the modifier should not be used. The Medicare Preventive Service Benefit manual does not reference this modifier as applicable for laboratory testing billed to the Medicare program. For now, the use of this modifier for billing of laboratory services should be limited to the specific instruction of the commercial and private payers.

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