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01/31/22

What are Modifiers 96 and 97?

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!

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03/09/20

UHC Updates Habilitative Services and Outpatient Rehabilitation Therapy Coverage Determination Guideline

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

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03/04/19

UnitedHealthcare Updates Habilitative Therapy Policy

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

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