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Question

Modifiers 96 & 97

  • July 22, 2026
  • 2 replies
  • 39 views

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As a pediatric OT/ST/PT clinic we provide both habilitative and rehabilitative services and therefor have a need for modifier 96/97 on a patient case level. However, after talking with a rep today, it seems that our only current option to code correctly with Fusion is to put these modifiers on each individual claim.

Strange to me how they market as a therapy software but not allow a basic therapy modifier on a patient case.

The claim level edits are incredibly tedious and time consuming given our large volume of claims.

 

How are other clinics dealing with this? What am I missing?



 

2 replies

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  • Ensora Employee
  • July 22, 2026

Hi Jaybee. 

I think someone on our claim rules team can help with this.  We can set up a couple of code versions where you enter 12345-97 for example and then we can set a rule to apply the 97 modifier and set the code directly to 12345.   

If you can submit a case to fusion.support@ensorahealth.com and let them know what you need I am sure we can help to automate this.  

This would be more futureproof, but would require your therapists to know if you need a 96 or 97 on the code.  If that does not work, we can work with you to set up a patient specific set of rules, but it would need to modified when you have new patients to ensure they are added.  


 


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  • Author
  • New Participant
  • July 23, 2026

Thank you for the reply.

As this is something needed on a patient case level I will send an email to the support address you provided.