Modifier 96 | Habilitative Services Explained
Modifier 96 is a modifier that is used to describe habilitative services.
1. What is Modifier 96?
Modifier 96 is a CPT modifier that is used to indicate that a provider has delivered habilitative services to a patient.
Habilitative services are designed to help patients develop, maintain, or improve their skills to perform activities of daily living (ADLs) or instrumental activities of daily living (IADLs).
2. When to use Modifier 96?
Modifier 96 should be used when a provider delivers habilitative services to a patient. These services may include speech-language pathology (SLP), physical therapy (PT), or other habilitative services.
Habilitative services are different from rehabilitative services, designed to help patients regain skills they have lost due to injury, illness, or disease.
The official description of Modifier 96 is “Habilitative Services”.
Examples of procedures that may require Modifier 96 include:
- Speech therapy for a child who is not speaking at a reasonable age
- Physical therapy for a child who is not walking at a reasonable age
- Occupational therapy to help a patient develop fine motor skills
- Cognitive therapy helps a patient develop memory or problem-solving skills
To use Modifier 96, the provider must document the habilitative services that were delivered to the patient. The documentation should include the type of service, the duration of the service, and the goals of the service.
When billing for habilitative services, the provider should append Modifier 96 to the appropriate CPT code. The use of Modifier 96 may affect the reimbursement rate for the service.
7. Common mistakes
Common mistakes that medical coders make when using Modifier 96 include:
- Using Modifier 96 for rehabilitative services instead of habilitative services
- Failing to document the habilitative services that were delivered
- Failing to append Modifier 96 to the appropriate CPT code
To avoid these mistakes, medical coders should carefully review the documentation provided by the provider and ensure that Modifier 96 is used correctly.
8. Other modifiers related to Modifier 96
Other modifiers that may be related to Modifier 96 include:
- Modifier 97 – Rehabilitative Services
- Modifier 98 – Physical Therapy/Occupational Therapy Services
- Modifier 99 – Multiple Modifiers
When using Modifier 96, it is important to ensure that the documentation is complete and accurate. The documentation should include the type of service, the duration of the service, and the goals of the service.
Medical coders should also be familiar with the other modifiers that may be related to Modifier 96 and ensure that they are used correctly.