CPT modifier
Modifier 96: Habilitative services
Modifier 96 is a CPT modifier. In plain terms: The therapy service helps a patient learn or keep a skill or function they never had.
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- Modifier
- 96
- Type
- CPT (Level I) modifier, maintained by the AMA
- Plain description
- The therapy service helps a patient learn or keep a skill or function they never had.
- How it is used
- Separates habilitative care from rehabilitative care (97) where a plan counts the two benefits apart.
- Claim form
- CMS-1500 item 24D, up to four modifiers per line. 837P SV101-3 to SV101-6.
The CPT descriptor is AMA copyright and is not shown here. The description above is written by Rivvi. Read the CMS guidance linked above for Medicare's rules.
Therapy plans of care
- GPServices delivered under an outpatient physical therapy plan of care
- GOServices delivered under an outpatient occupational therapy plan of care
- GNServices delivered under an outpatient speech language pathology plan of care
- CQOutpatient physical therapy services furnished in whole or in part by a physical therapist assistant
- COOutpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
- KXRequirements specified in the medical policy have been met
- 97Rehabilitative services
Related modifiers
- GPServices delivered under an outpatient physical therapy plan of care
- GOServices delivered under an outpatient occupational therapy plan of care
- GNServices delivered under an outpatient speech language pathology plan of care
- CQOutpatient physical therapy services furnished in whole or in part by a physical therapist assistant
- COOutpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
- KXRequirements specified in the medical policy have been met
- 97Rehabilitative services
- 95Synchronous telemedicine (audio and video)
Related pages
Questions
What does modifier 96 mean?
Modifier 96 is a CPT modifier. In plain terms: The therapy service helps a patient learn or keep a skill or function they never had.
Is modifier 96 a CPT or a HCPCS modifier?
96 is a CPT (Level I) modifier. The AMA maintains CPT modifiers. Two-character codes with a letter, such as GT or XU, are HCPCS Level II modifiers from CMS.
Where does modifier 96 go on a claim?
On the CMS-1500 it goes in item 24D next to the procedure code. Each line holds up to four modifiers. On an 837P it goes in SV101-3 to SV101-6.
When is modifier 96 used?
Separates habilitative care from rehabilitative care (97) where a plan counts the two benefits apart.
What denial comes back when a modifier is wrong?
A missing or mismatched modifier often comes back as CARC 4. A modifier that was not valid on the date of service comes back as CARC 182. A bundling edit the modifier should have bypassed comes back as CARC 97 or 236.