CPT Code 97760 – Orthotic Management and Training (Initial Encounter)
CPT code 97760 is used for orthotic management and training during an initial encounter. It covers patient assessment, orthotic fitting, and training on the proper use of the device.
This code applies to the upper extremity, lower extremity, and trunk, and is billed in 15-minute increments. For subsequent encounters, CPT code 97763 should be used instead.
What Is CPT Code 97760?
CPT code 97760 represents Orthotic management and training, which includes:
- Assessing the patient’s orthotic needs
- Fitting and adjusting the orthotic device
- Educating the patient on proper usage
- Developing an individualized treatment plan
It’s primarily used by physical therapists, occupational therapists, and orthotists during the initial visit to help patients adapt to their orthotic devices.
CPT 97760 Code Description
CPT 97760 – Orthotic management and training (including assessment and fitting, when not otherwise reported); upper extremity, lower extremity, and/or trunk, each 15 minutes, initial encounter.
This code is time-based and should be billed per 15-minute session of orthotic assessment and training.
What Does CPT Code 97760 Include?
- Evaluation of patient’s physical condition and orthotic requirements
- Fitting and adjusting the orthotic device
- Instruction on orthotic application, removal, and care
- Training the patient in functional use of the orthosis
- Documentation of progress and recommendations
CPT Code 97760 vs. 97763
Code | Description | Use Case |
97760 | Orthotic management and training, initial encounter | Used for the first visit when the patient receives orthotic management |
97763 | Orthotic management and training, subsequent encounter | Used for follow-up or continued training sessions after the initial fitting |
Tip: Always document the encounter type (initial vs subsequent) to ensure accurate reimbursement and compliance with payer rules.
CPT Code 97760 Reimbursement
Reimbursement for CPT 97760 varies by payer and region, but typically ranges from $35 to $55 per 15 minutes.
Factors Affecting Payment:
- Payer policy (Medicare, Medicaid, commercial insurance)
- Documentation quality
- Modifiers used
- Place of service (clinic, hospital, home health)
Is CPT Code 97760 Covered by Medicare?
Yes, CPT 97760 is covered by Medicare when the service is medically necessary and properly documented.
To ensure coverage:
- A physician’s order is required
- Documentation must support the medical need for the orthosis
- The service must be performed by a qualified provider
Does CPT Code 97760 Need a Modifier?
Sometimes, yes. Common modifiers include:
- Modifier 59: Used when 97760 is billed with another procedure (e.g., manual therapy).
- Modifier GP: Indicates that the service was provided under a physical therapy plan of care.
- Modifier GO: Indicates an occupational therapy plan of care.
Always check payer-specific modifier rules to avoid claim denials
Can CPT Code 97140 Be Billed with 97760?
Yes, but only if the services are distinct and separately identifiable.
For example:
- 97140 (Manual therapy) addresses soft tissue mobilization.
- 97760 (Orthotic management) focuses on fitting and training for an orthosis.
Use Modifier 59 when both codes are reported on the same date of service to indicate separate, non-overlapping activities.
Documentation Tips for CPT Code 97760
- To ensure full reimbursement:
- Record the start and stop time of treatment.
- Include orthosis type and body part treated.
- Document training details and patient response.
- Specify if the encounter is initial or subsequent.
Common Payer Denial Reasons
- Missing documentation of time spent
- No modifier when required
- No physician order for orthotic management
- Coding 97760 for follow-up visits instead of 97763
Final Thoughts
CPT code 97760 plays a vital role in patient rehabilitation, helping providers manage orthotic fitting and training effectively. Proper documentation, accurate coding, and modifier use are key to maximizing reimbursement.
Partner with Express Medical Billing to ensure accurate coding, timely reimbursements, and compliance with payer policies for orthotic and therapy billing.
Disclaimer: This article is for informational purposes only. Always refer to current AMA CPT code guidelines and payer rules before billing.
Frequently Asked Questions (FAQs)
It’s used for orthotic management and training during an initial encounter, covering assessment, fitting, and patient education.
Yes, it’s billed per 15-minute session of orthotic training and fitting.
97760 is for the first encounter, while 97763 is used for subsequent follow-ups or training sessions.
Yes, use GP, GO, or 59 modifiers when required, depending on the therapy plan and payer guidelines.
Yes, it’s covered when the service is medically necessary, documented, and performed by a qualified therapist or orthotics.
Yes, if they represent separate and distinct procedures, supported by documentation, and billed with Modifier 59.
