CurrentPremera BluecrossPolicy N/A

Modifier 33 — Preventive Services

Defines when the Plan recognizes Modifier 33 on professional claims to indicate a preventive service and guidance for processing and reimbursement; applies to Premera Blue Cross and affiliated lines of business.

Policy Summary

PayerPremera Bluecross

PolicyModifier 33 — Preventive Services

Policy CodePolicy N/A

Change TypeAnnual reviewno changes

Effective DateN/A

Next Review DateMay 5, 2025

Key ActionAppend Modifier 33 to CPT/HCPCS codes when the service is provided as a preventive service per USPSTF A/B recommendations; do not append when service is for treatment of illness/injury.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Multiple linesScope of policy

USPSTF A/BClinical standards

Annual (05/05/25)Review cadence

Auditing/penaltiesEnforcement

Processing and Coverage Rules for Modifier 33

Processing rules

Criteria for processing services with Modifier 33:

Coverage is governed by member eligibility, benefit limits, and the Plan's Medical Policy; appending Modifier 33 does not override benefit limits or exclusions and final payment is subject to claim adjudication edits and coding policies.

Service must be consistent with United States Preventive Services Task Force (USPSTF) A or B recommendations in effect at the time of service to be recognized as preventive.

Reimbursement is restricted to the provider's scope of practice and the applicable fee schedule.

Do not append Modifier 33 when the service is rendered for treatment of illness or injury; appending the modifier does not guarantee preventive processing if member benefits or claim adjudication do not support preventive treatment.

Policy Summary

PayerPremera Bluecross

PolicyModifier 33 — Preventive Services

Policy CodePolicy N/A

Change TypeAnnual reviewno changes

Effective DateN/A

Next Review DateMay 5, 2025

Key ActionAppend Modifier 33 to CPT/HCPCS codes when the service is provided as a preventive service per USPSTF A/B recommendations; do not append when service is for treatment of illness/injury.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Billing Actions and When to Append Modifier 33

Billing Rule

When to append Modifier 33

Append Modifier 33 to CPT/HCPCS codes only when the service is provided as a preventive service consistent with USPSTF A or B recommendations; do not append when the service is rendered for treatment of illness or injury or when the code description is inherently preventive (example: 77067 screening mammography). Appending the modifier does not guarantee preventive processing if member benefits or claim adjudication do not support it.

Modifier 33 indicates a preventive service that waives patient cost share when eligible.
Use with diagnostic/therapeutic/screening CPT or HCPCS codes performed as preventive care.
Do not append for treatment-of-illness/injury services or codes inherently preventive by description (e.g., 77067).

Key Definitions

Modifier 33 — Preventive service

DefinitionIndicates a service is a preventive service that waives patient cost share when performed according to USPSTF A/B recommendations; should be appended to diagnostic, therapeutic, or screening CPT or HCPCS codes when rendered as preventive care.

Appropriate useAppend Modifier 33 when the service is provided as a preventive healthcare service consistent with USPSTF A or B recommendations in effect at the time of service.

When not to appendDo not append Modifier 33 when the service is rendered for treatment of illness or injury, or when the code description is inherently preventive (example: screening mammography 77067).

Effect on member cost shareAppending Modifier 33 indicates the service may waive patient cost share if claim adjudication and member benefits support preventive processing.

Patient Protection and Affordable Care Act (PPACA)

AcronymPatient Protection and Affordable Care Act (PPACA), also known as the Affordable Care Act; federal statute signed March 23, 2010.

Policy basisPolicy recognizes Modifier 33 as mandated under PPACA and aligns preventive coverage with PPACA requirements.

Relevant sectionsReferences PPACA §§ 4001–4004 and related interim final rules and PHS Act Section 2713 for coverage of preventive services.

PurposePPACA enacted to expand insurance coverage, lower costs, and improve quality and access to preventive services.

United States Preventive Services Task Force (USPSTF)

Full nameUnited States Preventive Services Task Force (USPSTF)

RoleIndependent volunteer panel of experts making evidence-based recommendations about clinical preventive services (screenings, counseling, preventive medications) for people without signs or symptoms.

Use in policyModifier 33 recognition requires the service to be consistent with USPSTF A or B recommendations in effect at the time of service.

Referenced materialsUSPSTF A and B service recommendations are listed among the policy references supporting preventive coverage determinations.

OpenPayer

Modifier 33 — Preventive Services

Processing and Coverage Rules for Modifier 33

Coding Guidance and Examples

Provider Billing Actions and When to Append Modifier 33

Key Definitions