CurrentFlorida BluePolicy 16-051

Reporting Habilitative and Rehabilitative Services

This payment policy governs how providers must report habilitative and rehabilitative therapy services (physical, occupational, speech) for Florida Blue members for claim processing and applies to all lines of business and providers.

Policy Summary

PayerFlorida Blue

PolicyReporting Habilitative and Rehabilitative Services

Policy CodePolicy 16-051

Change TypeNo material change

Effective DateSep 1, 2025

Next Review Date

Key ActionReport services that may be habilitative or rehabilitative with modifier 96 for habilitative or modifier 97 for rehabilitative appended to the procedure code.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Modifier 96Habilitative services reporting code

Modifier 97Rehabilitative services reporting code

All linesPolicy applies to

ProvidersWho is responsible

Coverage and Billing Criteria

Policy Summary

PayerFlorida Blue

PolicyReporting Habilitative and Rehabilitative Services

Policy CodePolicy 16-051

Change TypeNo material change

Effective DateSep 1, 2025

Next Review Date

Key ActionReport services that may be habilitative or rehabilitative with modifier 96 for habilitative or modifier 97 for rehabilitative appended to the procedure code.

SourceLink

On This Page

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ALL of the following

Policy applies to all lines of business and providers of service; this document provides billing/reporting guidance but is not an authorization or guarantee of payment (benefits determined by group contract and member benefit booklet).
Services that may be either habilitative or rehabilitative must be reported with an appropriate modifier appended to the procedure code to differentiate the service type for claims processing.
ALL of the following
- Report habilitative services with modifier 96 (Habilitative Services).
- Report rehabilitative services with modifier 97 (Rehabilitative Services).
Modifiers may be used on CMS 1500 or UB04 claim forms or electronic equivalents when billing.
Professional and institutional providers are responsible for appropriately reporting services performed.

Modifier Reporting Requirement and Provider Responsibilities

Billing Rule

Append modifier 96 or 97 to distinguish habilitative vs rehabilitative services

Report services that may be either habilitative or rehabilitative by appending the appropriate modifier to the procedure code: use modifier 96 for habilitative services and modifier 97 for rehabilitative services. These modifiers may be used on a CMS 1500 or UB04 claim form or electronic equivalents to differentiate service type for claims processing.

Apply modifier 96 to services that are habilitative.
Apply modifier 97 to services that are rehabilitative.
Modifiers are permitted on CMS 1500, UB04, or electronic equivalents.

Definitions: Habilitative and Rehabilitative Services

Habilitative services — definition and short description

DefinitionHabilitative services are health care services that are short-term and help a person to acquire or attain an age-appropriate bodily function necessary to participate in activities of daily living; they help a person keep, learn, or improve skills and functioning for daily living.

Typical servicesMay include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in inpatient and/or outpatient settings.

ExampleTherapy for a child who is not walking or talking at the expected age.

Rehabilitative services — definition and short description

DefinitionRehabilitative services are health care services rendered for the purpose of restoring function lost or impaired after an illness, injury, or surgical procedure.

PurposeIntended to restore function that was lost or impaired due to a medical event or surgery.

SettingsProvided in a variety of inpatient and/or outpatient settings as appropriate to the member's needs.

96, 1	Habilitative Services (as listed: 96, 1)
97, 1	Rehabilitative Services (as listed: 97, 1)

OpenPayer

Reporting Habilitative and Rehabilitative Services

Coverage and Billing Criteria

Modifier Codes for Habilitative / Rehabilitative Services

Modifier Reporting Requirement and Provider Responsibilities

Definitions: Habilitative and Rehabilitative Services