January 23, 2025 | Net Health
6 min read
Habilitative vs. Rehabilitative Therapy: Key Concepts
“What’s in a name?“ mused Shakespeare’s Juliet. While a rose by any other name would smell as sweet, there are key differences between habilitative vs. rehabilitative services. While the two words seem similar, their definitions and applications differ.
Before January 1, 2017, most insurance carriers did not require providers to distinguish between habilitative and rehabilitative services on the claim form. Many, including big players such as BlueCross, had a combined visit maximum for both types of care. Now, many plans have a separate benefit of 15 visits for each type of service. Knowing how those differences can affect documentation and billing in your practice is essential.
Habilitative vs. Rehabilitative: The Differences
Habilitative Therapy
Habilitative therapy helps patients acquire, maintain, or improve skills and abilities that they may not have developed or may have difficulty developing naturally. The focus is on teaching skills individuals have not learned due to developmental delays, congenital conditions, or early-onset disabilities.
Applications
The treatment approach typically requires long-term intervention as developmental steps are being taught. The focus is on logical progression in teaching new skills.
The populations typically served by this therapy are those with developmental disabilities, autism spectrum disorders, cerebral palsy, or genetic disorders. These populations may work with physical therapists, occupational therapists, and even speech-language pathologists to acquire these new skills. This means rehab therapists of all types and in a variety of settings, from private practice to hospital inpatient clinics, might be tasked with performing habilitative therapy.
Skills that patients might work on when undergoing habilitative therapy include:
- Gait training, from walking to managing stairs.
- Motor skills, like those involved in daily tasks such as washing dishes and brushing teeth.
- Occupational tasks that patients may encounter in the workplace
- Balance and other tasks requiring nervous system control
- Prehabilitation used to prevent injury in athletes
- Speech therapy for speech impediments
Rehabilitative Therapy
In contrast, rehabilitative therapy helps patients regain skills or abilities lost due to injury, illness, or disability. The goal is to restore patients to their previous level of function, or at least as close as possible.
Applications
The timeline for this therapy is more structured. The goal is to return to a previous level of function, and protocols based on the treated condition are often included. That may mean fewer overall sessions, something that therapists can keep in mind while creating a treatment plan for patients if their insurance includes a cap on rehabilitative sessions.
This is often used in recovery from surgery, sports injuries, or accidents. Stroke and traumatic brain injuries are another category often treated with rehabilitative therapy. While the skills that rehabilitative therapy seeks to treat cover a number of areas, rehabilitative therapy is most often performed by physical therapists. In some cases, occupational therapists may treat injury, stroke, or recovery from other medical conditions, but this is limited to skills that will have an impact on the patient’s occupation, as the name suggests. Speech-language pathologists are least likely to perform rehabilitation therapy.
As they’re typically performing treatment that involves restoring movement and skill, rehabilitation therapy often occurs in a number of care settings. Hospital inpatient clinics may see patients fresh out of surgery or amputees learning how to use their prosthetics. Hospital outpatient and private practice clinics are more likely to treat sports injuries and rehabilitation later in the recovery process.
Rehabilitation therapy might include:
- Injuries from sports, construction, or daily living activities
- Post-surgical recovery, including joint replacements and amputations
- Injuries sustained during car accidents or other traumatic events
- Occupational skills, like grip strength and joint mobility following a hand injury
Summary
Habilitative | Rehabilitative |
Learn new skills | Restore lost function |
Progresses developmentally | Returns to baseline |
Long-term | Time-limited |
May be ongoing | Typically has end-point |
The Confusion between Habilitative vs. Rehabilitative
According to the American Occupational Therapy Association (AOTA) and the American Physical Therapy Association (APTA), both habilitative and rehabilitative therapies can involve the same kind of treatments to address the same deficits and have the same overall goals. Still, the difference is whether the patient is learning something new or relearning an already-acquired skill.
To make matters more confusing, the same patient can receive rehabilitative and habilitative services. For example, a child with cerebral palsy who has had surgery could receive rehabilitative therapy to assist in recovery and still receive habilitative therapy for walking. According to the APTA, however, you cannot provide both services using the same treatment goal. The goals should clearly define the intent of the services being provided.
Take the example of that child with cerebral palsy. Their post-surgery recovery, which may include increasing the strength of the upper body and returning the arms and hands to their capabilities prior to the surgery would be rehabilitative therapy. If they’ve been unable to walk prior to the surgery, continuing to work with a therapist on ambulation and gait training would fall under habilitative therapy.
Similarly, an athlete who’s suffered a lower back injury would likely receive rehabilitative therapy to heal the injury and return the lower back to its baseline range of motion and strength. If they also realize that their shoulder or hip joints are not performing properly to accommodate the stressors of their sport, they may also undergo habilitative therapy to learn sport-specific skills to protect their joints.
Documentation and Billing
As of January 1, 2018, modifiers 96 and 97 replaced the SZ modifier, which had been used to indicate habilitative services. The modifier 96 is used to identify habilitative services, while modifier 97 is used for rehabilitative therapy.
It is important to note that not all health plans will utilize separate visit limits for billing. Only individual and small group plans in compliance with the Affordable Care Act (ACA), Medicaid managed care, and certain individuals eligible for Medicaid are required to provide separate visit limits. As changes in coding are ongoing, rehab therapists should communicate with payers to understand the existing visit limits for each service and their policy regarding modifiers 96 and 97.
The Tale of Two Treatment Paths
While rehabilitation and habilitation offer similar therapies, the key distinction remains whether the skill is new or existing. The difference is important to insurers, but as a therapist, your treatments will be tailored to each patient to assist them in gaining independence. You can avoid getting overwhelmed by the reimbursement details by having an EMR designed to optimize all types of therapy and assist with documentation, which will help you focus on providing the best therapy.
Get the Right EMR for Your Clinic
Your EMR should help you manage your workload and produce better patient outcomes