What Is Modifier On Insurance Form 96 And 97

Learn about humana s policy requiring the use of modifiers 96 and 97 habilitative and rehabilitative services when submitting claims for many of your patients covered by humana commercial plans.

What is modifier on insurance form 96 and 97. The new modifiers replaced the sz modifier for habilitative services unless instructed otherwise by an insurance carrier. Rehabilitative modifier 97 services that help a person restore functions which have become either impaired or lost. Requirements may vary from payer to payer. Some insurance companies may have been requiring use of the sz modifier in order to make that distinction.

Let s examine some key concepts excerpted from one payer s policy emphasis added. What are the definitions of each modifier and when would you use each modifier for outpatient therapy services. Rehabilitative modifier 97 services that help a person restore functions which have become either impaired or lost. Modifiers indicate that a service or procedure performed has been altered by some specific circumstance but not changed in its definition or code.

Services that help a person develop skills or functions they didn t have before. As of january 1 2018 modifiers 96 and 97 replaced the sz modifier which providers were previously using to indicate habilitative services per cms transmittal 3940. Speculation on the reason for the two new modifiers suggests that they are intended to help payers better track the number of rehabilitative versus habilitative visits both considered. The 2 new modifiers that became effective january 1 2018 are modifier 96 and modifier 97.

Modifiers 96 and 97 habilitative and rehabilitative services updated january 2020. Services that help a person develop skills or functions they didn t have before. This presentation includes a printable tip sheet. Habilitative modifier 96.

Previously the sz modifier indicated a service was performed for habilitative purposes while no modifier indicated the service was for rehabilitative purposes. They are used to add information or change the description of service in order to improve accuracy or specificity. Requirements may vary from payer to payer.