Although they are frequently used in conjunction, there is a difference between habilitation and rehabilitation in physical therapy. A thorough understanding of the distinction between the two is required for proper navigation of the documentation and billing processes.
Following an illness or injury, rehabilitative therapy consists of a variety of services that aid in the restoration and improvement of health functions and skills required for daily living.
Habilitative and Rehabilitative Physical Therapy (PT) Services May Involve the Same Approaches
Habilitative vs Rehabilitative Physical Therapy (PT) Billing Differences
Despite having a thorough awareness of the differences between habilitative and rehabilitative treatment services, therapists must also know how CPT codes apply for reimbursement. To fully understand why these services are paid separately, it is necessary to analyze the 2017 federal law that imposed distinct visit limitations for habilitative and rehabilitative services to provide equal coverage.
How Does the CPT Code Apply To Rehabilitative and Habilitative Physical Therapy?
The Centers for Medicare & Medicaid Treatments (CMS) established modifiers 96 and 97 on January 1, 2018, to replace the SZ modifier, which was previously used by physical therapists to represent habilitative services.
The differences between modifier 96 vs. 97 are as follows:
- Modifier 96 is used to identify habilitative services and procedures.
- Modifier 96 is also to be used if habilitative services rendered can be considered either habilitative or rehabilitative.
- Modifier 97 is used to identify rehabilitative services and procedures.
- Modifier 97 is also to be used if rehabilitative services rendered can be considered either rehabilitative or habilitative.
Showing Service Type in Documentation
Is it possible for a patient to receive both types of services?
To Whom Does This Apply?
Ongoing changes in coding can be quite a challenge. To help avoid costly errors with your billing documentation processes, work with trusted billing service providers that work hand-in-hand with scheduling modules to ensure each patient visit is billed correctly. Don’t slow down your reimbursement with confusion over Habilitative vs Rehabilitative Physical Therapy (PT) Billing processes. Zee Medical Billing can help simplify and safeguard your billing and documentation.