Habilitative Speech Therapy, is care provided for conditions which have limited the normal age appropriate motor, sensory or communication development. To be considered habilitative, functional improvement and measurable progress must be made toward achieving functional goals within a predictable period of time toward an individual’s maximum potential.
Functional skills are defined as essential activities of daily life common to all individuals such as dressing, feeding, swallowing, mobility, transfers, fine motor skills, age appropriate activities and communication. Problems such as hearing impairment including deafness, a speech or language impairment, a visual impairment including blindness, serious emotional disturbance, an orthopedic impairment, autism spectrum disorders, traumatic brain injury, deaf-blindness, or multiple disabilities may warrant Habilitative Therapies.
Measurable progress emphasizes accomplishment of functional skills and independence in the contest of the individual’s potential ability as specified within a care plan or treatment goals
Habilitative/Rehabilitative therapy services must be reported with the 96 or 97 modifiers in conjunction with the appropriate therapy code.
Habilitative therapy is not eligible for payment, unless the member has a habilitative benefit.