Habilitation services do not require authorization
November 12, 2024
This article is for:
- Physicians and clinicians who refer members for habilitation services
- Physical and occupational therapists who perform habilitation services
Please share with your authorization department
We continue to receive authorization requests for habilitation services even though we removed the authorization requirement as of September 1, 2024 for our commercial HMO and POS members1 who receive care from in-network providers.
Habilitation services are health care services that help a person keep, learn, or improve skills and functioning for daily living. These services are typically billed with modifiers 96 and SZ.
Some members have outpatient benefits for habilitation care that are separate from their benefits for rehabilitation2 care.
Resources
- Habilitation Services page
- News Alert. To read our July 1, 2024 notification about the removal of this authorization requirement, log in and go to News. Sort by date to find July 1, 2024, and you’ll see this headline, “We’re removing authorization for habilitation services.”
- Includes New England Health Plan members with a PCP in Massachusetts.
- Rehabilitation services are health care services that help a person to regain skills and function after an acute illness, injury, or surgery.
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