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) 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 (UHC) Individual Exchange Plan has announced they will begin requiring additional modifiers be appended to CPT codes on both the 1500-claim form and UB-04 claim form in order for outpatient therapy services to be reimbursed. Failure to append the new modifiers on each CPT code will result in those claim lines being rejected. The new modifiers that are required beginning with dates of service on and after September 1, 2021 are either Modifier 96 or Modifier 97. Modifier 96 is to be appended to the CPT code on the claim form to indicate that the service is Habilitative in

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