I'm trying to locate a definitive source that either supports or refutes appending modifiers -96 (hab) or -97 (rehab) to manipulation treatment codes (98925-98943), or anyone that has experience with chiropractic/osteopathic coding & billing.
From what I can infer from my research modifiers -96 & -97 are applicable to therapy/modalities, but I've been unable to find anything about adding these modifiers to distinguish the two among manipulation treatments.
Also, I'm viewing this within the scope of Marketplace/Exchange coverage which list hab & rehab as EHB. So for states that have manipulation therapy under both benefits, is there a coding standard of differentiation?
Habilitative (modifier 96): services that help a person DEVELOP skills or functions they didn't have before.
Rehabilitative (modifier 97) services that help a person RESTORE functions that have become either impaired or lost.
This information is covered in an article written by Wyn Staheli for ChiroCode, you can view it here. Find-A-Code also has a TOPIC page for Chiropractic where her articles are FREE.
Using Modifiers 96 and 97
Q/A: Should I be Using Modifier 96 on PT Claims?
Requirements may vary from payer to payer, Here are a few examples: