Effective for dates of service on and after January 1, 2018, there were 2 new modifiers that providers of outpatient physical, occupational and speech therapy may be required to use with some insurance carriers, such as Affordable Care Act (ACA) compliant plans, to distinguish whether the service provided was rehabilitative in nature or habilitative in nature. The new modifiers replaced the SZ modifier for habilitative services, unless instructed otherwise by an insurance carrier.
The 2 new modifiers that became effective January 1, 2018 are Modifier 96 and Modifier 97. What are the definitions of each modifier and when would you use each modifier for outpatient therapy services?
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