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Modifier 97

CPT numeric modifiers (AMA · CPT Appendix A)

Modifier 97. Rehabilitative Services — services to restore previously held skills lost to illness/injury (effective 1/1/2018).

Reference only — CPT descriptors are AMA-copyrighted (paraphrased). Payment percentages and acceptance vary by payer; verify against the current CPT/HCPCS files and payer policy.

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Increased Procedural Services — work substantially greater than typical. Require…
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Unusual Anesthesia — general anesthesia used where the procedure usually needs n…
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Unrelated E/M During a Postoperative Period — same physician provides an E/M unr…
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Significant, Separately Identifiable E/M on the Same Day as a Procedure — E/M ab…
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Professional Component — bills only the physician's interpretation/supervision p…
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Multiple Outpatient Hospital E/M Encounters on the Same Date — facility (hospita…
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Mandated Services — service required by a third party (e.g., a payer-mandated se…
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Preventive Services — flags an ACA-designated preventive service so commercial p…

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