Because there can be crossover and even patients who are receiving both types of services, it important to clearly document what you are providing and the intent behind that care. Reflecting Type of Service in Your DocumentationĪs always, proper documentation is key to compliance. Supplying appropriate reasoning to the modifier listed helps better communicate the patient's treatment plan and reduces billing slowdowns and errors. When reporting these modifiers to a health plan provider, PT practices should also provide documentation that the services rendered are to help a patient either learn something new or regain a function that was lost. Insurances are increasingly requiring the use of these modifiers so keep your eye out for these changes as time goes on. Modifier 97 is also to be used in the event that rehabilitative services rendered can be considered either rehabilitative or habilitative.Modifier 97 is used to identify rehabilitative services and procedures.Modifier 96 is also to be used in the event that habilitative services rendered can be considered either habilitative or rehabilitative.Modifier 96 is used to identify habilitative services and procedures. On January 1, 2018, the Centers for Medicare & Medicaid Services (CMS) introduced modifier 96 and modifier 97 to replace the SZ modifier, which was previously used by PTs to indicate habilitative services. To best understand why these services are billed separately, the key is to review the 2017 federal law that mandated separate visit limits for habilitative and rehabilitative services to provide equal coverage. rehabilitative treatment services work, therapists must also understand how CPT codes apply for reimbursement. How Does the CPT Code Apply To Rehabilitative and Habilitative Physical Therapy?ĭespite a comprehensive understanding of how habilitative vs. Therefore, though the interventions are the same, one is habilitative in nature, while the other is rehabilitative. However, the difference between the two care plans would be that the treatment goals for each differ due to the specific injuries and conditions the patients are dealing with. Both rehabilitative and habilitative PT services can address the same functional outcomes, even in patients with drastically different diagnoses. rehabilitative physical therapy services, it’s important to note that the two can involve the same interventions. Rehabilitative and Habilitative PT Services Can Involve the Same Interventions Habilitative therapy refers to services used to help patients learn, maintain, and improve common skills that have not been acquired at the age-appropriate level, despite being necessary for daily living.Ī quick way to think about this is that habilitative therapy helps patients DEVELOP skills. Rehabilitative therapy consists of various services that aid in the restoration and improvement of health functions and skills necessary for daily living following an illness or injury.Ī quick way to think about this is that rehabilitative therapy helps patients RESTORE functions. A thorough comprehension of the distinct difference between the two is essential to navigating the documentation and billing processes properly. Though the two may sound similar, there is a difference between habilitation and rehabilitation pertaining to physical therapy. What is the Difference Between Rehabilitative and Habilitative? rehabilitative care and when to use the appropriate claims modifiers. Here’s what you need to know about habilitative vs. habilitative services, including how to meet provider reporting requirements. To ensure proper reimbursement from payers, physical therapists and therapist assistants alike must understand the differences between rehabilitative vs. There's a lot to sort through when billing, from ever-evolving claims modifiers to ongoing updates to federal regulations. Just when you thought things couldn’t become any more complicated, you learn that habilitative and rehabilitative services must be billed separately. rehabilitative billing process can be tricky. Rehabilitative Therapy Billing Differencesįor physical therapy providers, navigating the habilitative vs.
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