Modifier Code 33

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 code. For separately reported services specifically identified as preventive, the modifier should not be used.

Beginning July 1, 2012, HMSA will require modifier code 33 to be appended for certain preventive health services. When these services are rendered by a participating provider and billed with modifier code 33, the member will have no cost share. If the services are not billed with modifier code 33, the plan's regular benefits will apply.

Please refer to the following documents to identify the specific services that require modifier code 33.

• Preventive Health Guidelines - Men
• Preventive Health Guidelines - Newborns and Children
• Preventive Health Guidelines - Prenatal Care
• Preventive Health Guidelines - Women

Revision History