New Modifier Requirements

Date: 03/25/19

Habilitative and rehabilitative benefits are considered Essential Health Benefits (EHBs) under the Affordable Care Act (ACA). Habilitative services help a person learn, keep, or improve skills and functioning for daily living. While rehabilitative services are necessary after an illness or injury to help a person restore, keep, or improve skills and functioning for daily living.

Many times, the same CPT code can be used for both types of services. On January 1, 2018, new modifiers were introduced to help distinguish between two benefits.

New Modifier Requirements (PDF)