When do you use modifier 33 and PT?
Modifier 33 is a valid CPT modifier and may be used for all payers. Check with individual payers for their instructions. Modifier PT is more specialized and will be used by fewer practices. It is a HCPCS modifier, used to indicate that a colorectal screening service converted to a diagnostic or therapeutic service.
What is a 33 modifier used for?
Modifier 33 is applied to indicate that the preventive service is one that waives a patient’s co-pay, deductible, and co-insurance. An exception is that modifier 33 does not have to be appended to those services that are inherently preventive (for instance, screening mammography).
What is modifier PT used for?
Modifier PT CMS developed the PT modifier to indicate that a colonoscopy that was scheduled as a screening was converted to a diagnostic or therapeutic procedure. The PT modifier (colorectal cancer screening test, converted to diagnostic test or other procedure) is appended to the CPT® code.
Is CPT 45378 covered by Medicare?
–CPT code 45378, which is used to code a diagnostic colonoscopy, is on the list of procedures approved by Medicare for payment of an ambulatory surgical center (ASC) facility fee under §1833(I) of the Act.
Does CPT 45378 need a modifier?
CPT code 45378 is the base code for a colonoscopy without biopsy or other interventions. It includes brushings or washings, if performed. If the procedure is a screening exam, modifier 33 (preventative service) is appended.
Does Medicare pay for modifier 33?
Medicare payors do not recognize modifier 33, and will not reimburse claims submitted with the modifier. Medicare requires the use of dedicated G codes to describe covered preventive services (e.g., G0202 Screening mammography, producing direct digital image, bilateral, all views).
Does CPT 45378 require a modifier?
Is PT a Medicare modifier?
PT modifiers– two-digit codes applied to CPT codes and are typically included when billing both Medicare and commercial insurances.
What does CPT code 45378 mean?
A family of CPT codes applies to colonoscopy. For example, code 45378 applies to a colonoscopy in which no polyp is detected, while codes 45380-45385 apply to colonoscopy that involves an intervention (e.g., 45385 is the code for colonoscopy with polypectomy.)
What is procedure code 45378?
Is CPT 45378 surgery?
CPT® 45378, Under Endoscopy Procedures on the Rectum The Current Procedural Terminology (CPT®) code 45378 as maintained by American Medical Association, is a medical procedural code under the range – Endoscopy Procedures on the Rectum.
Does Medicare accept PT modifier?
Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary. The use of the PT modifier is also a Medicare rule, see information below from the WPS website.
What is the modifier for CPT code 45378?
CPT code 45378 is not inherently a screening code, so modifier 33 should be appended if it was a screening service. This is different from medicare’s modifier PT, which is only appended to screening services that become therapeutic.
What are modifiers 33 and PT in billing?
Modifiers 33 and PT are key components to submitting accurate preventive services claims; as such, it’s important to review and become familiar with the following billing guidance. Modifier 33** The appropriate use of modifier 33 will help reduce claim adjustments related to preventive services and your corresponding refunds to members.
What is the modifier 33 for colonoscopy?
Modifier 33 will impact how the claim is paid only for colonoscopy procedures. Modifier 33 should not be applied to nonpreventive colonoscopies (done to evaluate signs, symptoms, follow-up or existing conditions). • Modifier PT – Colorectal cancer screening test; converted to diagnostic test or other procedure.
What is mod 33 in CPT code?
Modifier 33 applies to commercial lines of business only. ** CPT modifier 33 is applicable to preventive services that do not have a unique code for such services (e.g., E&M codes such as, 99401 would not require modifier 33 as this code already indicates a preventive medicine service.