Third Party Payor Denial Of Modifier -3


Concerning screening colonoscopies, our ambulatory surgery center is having no problem using the -PT modifier for Medicare but third-party payors are not accepting the -33 modifier. Do you know why this would be happening and what we can do about it?

Jessica Edmiston: The 33 modifier became effective Jan. 1 but wasn’t actually published until April 1.

Sometimes there can be a delay in carriers updating their systems to support new CPT codes and modifiers. We would recommend working with the provider representative for all carriers and finding out if their system has been updated to support the new modifier.

If their system has not been updated, try to find out when the system will be updated and what modifier should be used until the update occurs.

Note: The description for modifier -33 is as follows: 33 Preventive Service: 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 appending modifier 33, Preventive Service, to the service. For separately reported services specifically identified as preventive, the modifier should not be used.

Modifier -33 is to be reported for all carriers other than Medicare and is used in similar circumstances as the -PT modifier for Medicare.

Jessica Edmiston is Senior Vice President, Coding for National Medical Billing Services

This post was first published May 26, 2011 and was updated July 29, 2020

Jessica Edmiston, Senior Vice President, Coding

Jessica Edmiston BS, CPC, CASCC AHIMA Senior Vice President, Coding Jessica leads National Medical's outstanding coding team that is comprised of the most experienced and skilled surgical coders in the country. She obtained her Bachelor of Science in Education from the University of Missouri in St. Louis and has been credentialed with the highly acclaimed Certified ASC Coder (CASCC™) Credential. Additionally, Jessica is an approved ICD-10-CM trainer through AHIMA. Nationally renowned for her coding expertise, Jessica is requested by name to speak at large conferences and authors numerous articles in medical trade journals and publications. Working closely with National Medical’s Performance Review department, Jessica identifies coding compliance issues and areas of missed revenue while proposing best practice coding solutions. Jessica also ensures the coding team receives continuing education to remain abreast of the medical coding updates while deepening their coding expertise. In her free time, Jessica enjoys traveling to beaches as well as camping and exploring several of the beautiful national parks of Utah.

Read more by this author

Recent Posts