Manipulation Therapy & Habilitative/Rehabilitative Services

Hello all,

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?

Thank you for your time!

re: Manipulation Therapy & Habilitative/Rehabilitative Services

What's the Difference?

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
https://www.aota.org/-/media/corporate/files/advocacy/health-care-reform/essential-benefits/habilitative%20services%20fact%20sheet.pdf

Q/A: Should I be Using Modifier 96 on PT Claims?
https://panel.findacode.com/my-articles-view.html?id=34607&view

Requirements may vary from payer to payer, Here are a few examples:

AmeriGroup
https://medpol.providers.amerigroup.com/dam/medpolicies/amerigroup/active/guidelines/gl_pw_a051172.html

AOTA
https://www.aota.org/-/media/corporate/files/advocacy/health-care-reform/essential-benefits/habilitative%20services%20fact%20sheet.pdf
.