As a result of the Patient Protection and Affordable Care Act (PPACA), all health care insurance plans must cover preventive services (including immunizations) without any cost sharing. In other words, plans cannot impose cost-sharing requirements (ie, copayments, coinsurance, or deductibles) on specified preventive services when they are separately reported. Cost sharing is allowed when an office visit and covered preventive services are reported separately and the primary purpose of the visit is not for the provision of the covered preventive services. Also, payers may impose cost sharing for preventive services that are provided out of network.

Current Procedural Terminology has established modifier 33 (preventive service) in response to the PPACA and the requirements for reporting preventive services that have been cited in preventive service mandates (service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates...

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