Modifier 97 | Rehabilitative Services

Modifier 97 describes rehabilitative services that are provided to help restore or improve a patient’s skill or function that was lost due to injury or disease.

1. What is modifier 97?

Modifier 97 is a CPT modifier used to indicate that rehabilitative services were provided to help a patient regain or improve a skill or function lost due to injury or disease.

2. When to use modifier 97?

Modifier 97 should be used when a provider delivers rehabilitative services to help restore or improve a patient’s skill or function lost due to injury or disease. Rehabilitation may include physical or occupational therapy or speech–language pathology therapy.

3. Description

The official description of modifier 97 is: “rehabilitative services.”

4. Examples

Examples of procedures that may require modifier 97 include physical therapy to help a patient regain strength and mobility after a stroke, occupational therapy to help a patient relearn daily living skills after a traumatic brain injury, and speech therapy to help a patient regain the ability to communicate after a stroke.

5. Documentation

To use modifier 97, the medical record must clearly document that the rehabilitative services were provided to help restore or improve a patient’s skill or function lost due to injury or disease.

The documentation should include the type of therapy provided, the goals of the therapy, and the patient’s progress towards those goals.

6. Billing

When billing for rehabilitative services with modifier 97, the provider should use the appropriate CPT code for the therapy provided (such as 97110 for therapeutic exercises or 92507 for speech therapy) and append modifier 97 to indicate that the services were rehabilitative.

7. Common mistakes

Common mistakes when using modifier 97 include using it for services that are not rehabilitative, failing to document the rehabilitative nature of the services, and using it in conjunction with other HCPCS therapy modifiers (such as modifier GP, modifier GO, or modifier GN) when it is not appropriate to do so.

To avoid these mistakes, coders should carefully review the medical record and ensure that the documentation supports modifier 97.

8. Other modifiers related to modifier 97

Other modifiers related to modifier 97 include the HCPCS modifier GP for physical therapy, HCPCS modifier GO for occupational therapy, and HCPCS modifier GN for speech-language pathology.

These modifiers indicate the type of therapy provided and should be used in conjunction with modifier 97 when appropriate.

9. Tips

When using modifier 97, ensure that the documentation supports the rehabilitative nature of the services provided.

Providers should also ensure that they are using the appropriate code for the therapy provided and that they are appending modifier 97 only when appropriate.