AMA CPT® Assistant - 2012 Issue 12 (December)
CPT Assistant Bulletin 22-2 (2012)
CPT Assistant Bulletin 22-2 (2012) page 1 Preventive Services and Use of Modifier 33 Much of our nation's increased health care spending is due, in large part, to the increased prevalence of chronic conditions, such as high blood pressure and diabetes, and unhealthy lifestyle behaviors, such as poor nutrition, physical inactivity, and smoking and alcohol misuse. By expanding preventive care, we can decrease health care costs, increase efficiency in health care spending, reduce the burden of preventable disease, and achieve the ultimate goal: help more patients to live healthier lives. Background With the passage of the Affordable Care Act...
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Article Overview
This bulletin discusses preventive services policy under the Affordable Care Act, including general coverage context, cost-sharing concepts, and how preventive services may be identified in billing workflows. It is aimed at coding and billing professionals, physicians, and practice staff who need to understand preventive services reporting in relation to CPT and related HCPCS guidance. The article also includes an extensive table of preventive service categories and preventive medicine clinical examples to illustrate the scope of the topic.
Why This Topic Matters
Preventive services billing can affect patient cost-sharing, claim processing, and alignment with payer requirements. Understanding the article helps readers recognize the kinds of preventive services and preventive medicine encounters addressed in current coding guidance.
Article Sections
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Preventive Services and Use of Modifier 33
Introduces the article’s focus on preventive services policy and billing context. Summarizes broad background on preventive care coverage and the role of modifier 33.
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Background
Provides legislative and regulatory context for preventive service coverage. Describes the general categories of preventive services referenced in the bulletin.
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Cost-Sharing Rules
Discusses general cost-sharing considerations tied to preventive services. Notes how payer coverage and claim handling may vary in different situations.
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Modifier 33
Explains the purpose and general reporting context for modifier 33. Also references related HCPCS Level II modifiers and broader preventive service mandates.
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Preventive services that are identified as not requiring cost sharing include the following categories
Lists broad preventive service categories associated with preventive care coverage. The section includes references to several external organizations and annual recommendation sources.
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Table 1. USPSTF "A" and "B" Recommendations for Preventive Services
Presents a table of preventive service topics, grades, and dates in effect. The table reflects a range of screening, counseling, and preventive care subjects tied to USPSTF recommendations.
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Clinical Examples of Preventive Services
Provides preventive medicine clinical examples tied to evaluation and management reporting. The examples show the scope of preventive visits across different patient ages and settings.
What You Will Learn
- How preventive services are discussed in the context of ACA-related coverage
- What general types of preventive care topics are included in the bulletin
- How the article frames modifier 33 within preventive services reporting
- What broad categories of preventive services appear in the USPSTF recommendation table
- How preventive medicine clinical examples are used to illustrate visit documentation scope
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Physicians
- Practice managers
- Compliance and revenue cycle staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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