Modifier 97- Rehabilitative Services

Modifier 97 is used to identify rehabilitative services provided to help patients restore or regain functional abilities lost due to illness, injury, or surgery.

What is Modifier 97?

Modifier 97 identifies rehabilitative services that focus on restoring, improving, or maintaining functional abilities that a patient previously possessed but lost because of an illness, injury, surgery, or medical condition. It distinguishes rehabilitative therapy from habilitative therapy, which helps patients develop skills they have not previously acquired.

When to Use Modifier 97

• Rehabilitative therapy services are medically necessary.

• The patient is working to restore previously acquired functional abilities.

• The reported therapy service qualifies for Modifier 97.

• Documentation supports medical necessity and treatment goals.

Billing Example

A physical therapist provides rehabilitation services to help a patient regain strength and mobility following total knee replacement surgery. Modifier 97 is appended to the eligible therapy service.

Documentation Tips

• Document the patient's diagnosis and functional limitations.

• Describe the patient's prior level of function.

• Include measurable treatment goals and progress.

• Verify payer-specific billing requirements.

Common Denial Reasons

• Documentation does not support rehabilitative therapy.

• Modifier reported on an ineligible service.

• Medical necessity is not established.

• Treatment goals or progress are not documented.

Related Modifiers

Modifier 96

Modifier GP

Modifier GO

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