Effective for dates of service on and after January 1, 2018, there were 2 new modifiers that providers 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. As we are now 4 years into the use of these new modifiers, we are starting to see some insurance carriers require the use of either Modifier 96 or 97 to be appended to the CPT code(s) on the claim form in addition to any other required modifiers. Let’s begin!

UnitedHealthcare (UHC) has updated and revised their Habilitative Services Benefit Interpretation Policy with an effective date of January 1, 2022. This updated/revised Benefit Interpretation Policy applies to the following states: Oklahoma Oregon Texas Washington To access the Benefit Interpretation Policy, click I hope you found this article to be informative. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.

UnitedHealthcare (UHC) Individual Exchange has a revised policy regarding Modifiers 96 and 97 that may have an impact on outpatient physical, occupational and speech therapy services. QuestionWhat is the policy title? Answer QuestionWhat are the changes to this policy? Answer QuestionWhat is the effective date of the revised policy? Answer QuestionHow can I access this update? Answer I hope you found this article informative and helpful. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without

UnitedHealthcare Commercial has updated their coverage determination guideline pertaining to Habilitative Services and Outpatient Rehabilitation Therapy with an effective date of April 1, 2020. In this updated coverage determination guideline, UHC lists certain CPT codes that are only payable as habilitative therapy services when they are billed with one of the habilitative diagnosis codes in the primary position on the claim. In addition, in this coverage determination guideline, UHC lists which ICD-10 diagnosis codes, when listed in the primary position on the claim form, qualify as habilitative therapy services only. In addition, UHC provides which CPT codes are payable for

UnitedHealthcare Commercial has updated their coverage determination guideline (CDG) for Habilitative Services and Outpatient Rehabilitation Therapy with an effective date of February 1, 2019. This updated CDG impacts habilitative services provided by physical therapists, occupational therapists and speech-language pathologists. To access the updated CDG, log into your Gold Member account and click