When should modifier 33 be applied?

Modifier 33 is specifically applied to indicate that a service was a preventive service that has been determined to have a significant benefit for the patient’s health. This modifier is used for preventive services that receive a rating of A or B from the United States Preventive Services Task Force (USPSTF). These ratings inform whether a procedure is evidence-based and recommended for preventive care.

When preventive services are provided, modifier 33 helps to signify to payers that these services should not be subject to cost-sharing for the patient, aligning with the Affordable Care Act guidelines that aim to enhance access to preventive health services. By applying this modifier, healthcare providers can ensure that patients are encouraged to receive preventive care without the hurdle of additional out-of-pocket costs.

In contrast, while the other options refer to relevant aspects of coding and billing, they do not pertain to the specific function of modifier 33. For instance, mandated consultations, procedures on both sides of the body, and procedures that require anesthesia are addressed by different modifiers that cater to specific circumstances or billing requirements, but they do not relate to the preventive nature of modifier 33.