Orthotic and Prosthetic CPT Code Clarification

Orthotic and Prosthetic CPT Code Clarification

? 97760 "Orthotic(s) management and training (including assessment and fitting when not otherwise reported, upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter," each 15 minutes. should be billed during the first (initial) visit of orthotic management

? 97761 "Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter," each 15 minutes.

? 97763 "Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter," each 15 minutes.

Please be aware of the following information:

? 97760/97761 should only be billed once during the initial visit for orthotic/prosthetic management and training. If additional visits are necessary to address ongoing training/management of the device 97763 should then be billed.

? An exception to this would be if during an established POC the therapist determines that it is appropriate to obtain another orthotic/prosthetic device for a different extremity or a different joint on the same extremity. In this case the initial visit for the added device would be billed under 97760/97761, each additional visit required would be billed under 97763.

? 97763 is not considered a covered service if billed with an OT or PT evaluation code. Please use 97760 or 97761 as appropriate if billing orthotic management/prosthetic training treatment during the time of evaluation.

Please reach out to cindyh@ or your Regional Director/Area manager with any additional questions.

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