May 4, 2017
Federal regulations require that health plans document rehabilitative and habilitative services as two different types of services, with separate visit limits. These requirements affect the coding for these types of visits. When billing for habilitative services, providers should use the available HCPCS modifier SZ (habilitative services). For electronic professional claims, the modifier is coded in the SV1 segment. For electronic facility claims, the modifier is coded in the SV2 segment.
What's the difference between habilitative vs. rehabilitative services?
Habilitative services are healthcare services and devices that help a person keep, learn, or improve skills and functioning for daily living. Rehabilitative services, including devices, are provided to help a person regain, maintain, or prevent deterioration of a skill or function that has been acquired but then lost or impaired due to illness, injury, or a disabling condition. Under the Affordable Care Act (2010), rehabilitative and habilitative services and devices are among 10 essential health benefits required to be covered by health plans.
For more information, see Update: Uniform Coding for Habilitative and Rehabilitative Services from the Blue Cross Blue Shield Association.