Modifer 96 & 97 for Physical Therapy: 2022 Telehealth POS Changes 

2022 is a few short weeks away (not sure where 2021 went, but that is for a different time) and we know that everyone is getting ready for the holidays, time with family and friends, good food, and of course, preparing for another year ahead. We also know that the end of year brings all of us new billing requirements, coding mechanisms, and various rule changes. Since the acquisition of TheraOffice, Netsmart has dedicated more time and effort to increase our educational content through blogs, webinars, and social media to save you time on keeping up with regulation and rehabilitation specific changes. Hopefully everyone is benefiting from the information (even if you are not a Netsmart TheraOffice client). 

Now we would like to make everyone aware of two important changes that may impact your physical therapy practice related to Modifiers (96 and 97) and Telehealth Place of Service (POS) changes.

Modifier 96 & Modifier 97

Although some payers implemented this change in 2021, more payers are requiring it in 2022. As of January 1st, 2022, United Health Care (UHC) will require therapists to differentiate between habilitative and rehabilitative treatment using modifiers 96 and 97, respectively.

Habilitative treatment would include all treatments that help patients develop a skill, movement, or function that they were not able to learn on their own. An example of this would be a pediatric patient who experienced a developmental delay and now requires therapy to learn the skill that they were unable to learn on their own.

Rehabilitative treatment consists of all treatments that help patients restore or regain a skill, movement, or function that was lost due to injury or illness. An example of this would be a patient who suffered a complex lower extremity fracture and now needs to re-learn how to walk.

The best way to address these requirements in TheraOffice would be using the contracted fee schedules. You can create one contracted fee schedule that has modifier 96 defaulted and/or create a second one that has modifier 97 set to automatically populate. Depending on your clinic’s patient population, you can either link the new contract fee schedule to your UHC insurance or you can set the 96 modifier fee schedule or the 97 modifier fee schedule in the patient’s case. Typically, a physical therapy patient will be categorized as needing habilitative therapy or rehabilitative therapy (in a case), so you will not need to change the fee schedule for a case.

Telehealth Place of Service (POS) Changes

If you are currently providing telehealth services to your patients, you are most likely utilizing POS 02; however, in 2022, a new POS will be introduced. With that said, POS 02 can be used if the telehealth services were provided somewhere other than the patient’s home. POS 10, the new POS, should be used if the patient is in their home at the time of the telehealth session.

POS 10 will be a part of TheraOffice’s .22 update, which will be released in December for both web and on-site customers. If you need the new POS prior to getting the update, please contact our support team and we can help get that added to your database.

As always, if any questions arise, please reach out to our support team or contact us at 1-800-842-1973.

About the Author

Ada Gudex, Manager & Senior Solution Strategist

As the Senior Director & General Manager of TheraOffice of our Specialty Practices Business Unit, Ada is responsible for leading a team focused on building out solutions and services to support organizations in the PT, OT, Speech Therapy markets. Prior to joining Netsmart, Ada held various leadership, consulting, project and product management roles at both small and larger companies – Assurant, Garmin, Center for Fiduciary Management, & Farmobile. Additionally, she served over 8 years as a Finance Officer in the US Army. Ada has a BS in Political Science from Georgia College and State University and a Masters of Human Resource Management from Florida International University. Ada leads with passion and lives by the motto – one day at a time!