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October 2016
New modifier for habilitative services, benefit limit changes for habilitative and rehabilitative care
To comply with an Affordable Care Act mandate, effective Jan. 1, 2017, Blue Cross Blue Shield of Michigan is making changes regarding the reporting of habilitative services and the benefit limits of both habilitative and rehabilitative services for individual business and some groups.
Habilitative services and how they differ from rehabilitative services
- Habilitative services: Health care services that help members keep, learn or improve skills and functioning for daily living.
- Rehabilitative services: Health care services that help members keep, recover or improve skills and functioning for daily living. These skills and functioning have been lost or impaired because members were sick, hurt or disabled.
New modifier needed for habilitative services
Health care providers must use the SZ modifier to identify any physical therapy, occupational therapy or speech-language pathology codes for habilitative services. The SZ modifier identifies habilitative services and allows us to track when habilitative (versus rehabilitative) services are reported.
Benefit limit changes
The benefit limits for rehabilitative and habilitative services for individual business and some groups will change, effective for plan years beginning on or after Jan. 1, 2017:
Habilitative services |
Benefit limit per calendar year |
Any combination of physical therapy, occupational therapy (excludes chiropractic and osteopathic manipulation) |
30 visits |
Speech therapy |
30 visits |
Rehabilitative services |
Benefit limit per calendar year |
Any combination of physical therapy, occupational therapy, chiropractic manipulation and osteopathic manipulation |
30 visits |
Speech therapy |
30 visits |
Note: The benefit limit varies by group. Remember to always verify patient’s eligibility for benefits. |
