2018 CPT Code Changes
The 2018 CPT codes have been officially released by the American Medical Association (AMA) and there are several changes that will impact outpatient physical and occupational therapy services. CPT codes, description, and material are copyright 2017 AMA. CPT is a trademark of the AMA.
2018 CPT code changes impact the following CPT codes:
- Multi-layer compression system CPT codes 29582 and 29583
- Orthotic and management training (CPT code 97760)
- Prosthetic management and training (CPT code 97761)
- Orthotic/prosthetic checkout (CPT Code 97762)
- Development of cognitive skills (CPT code 97532)
Lets begin with the multi-layer compression system CPT codes. For dates of service on and after January 1, 2018, the following CPT codes have
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For Medicare patients, do you propose private physician offices bill both L-Code and 97760? It seems redundant billing considering what the Lcode description has been.
Thanks in advance
Go to my Current News page and in the search box, type in words such as L Codes, 97760, Orthotics, etc. and read the articles I have written. The L codes do not include the training.
Where can I get more information on the description of the bandaging codes and also has Medicare assigned a payment value to these codes?
You can purchase CPT Changes 2012: An Insider’s View. You can also check out articles I written on CPT codes 29581-29584 at http://gawendaseminars.com/?submit.x=0&submit.y=0&s=29581
Is there any information for 2018 or 2019 that private practice clinics will be required to use EMR systems? Thank you
Not yet!
Any idea when Medicare will make a final decision on creating GXXX1?
My opinion is in the final rule which is due to be published on or around November 1, 2017.
Thank you.
Rick, if you initially bill 97760 for the time spent developing an orthotic for a patient’s left upper extremity and then further in your treatment must fabricate an orthotic for the same patient on a different body part, say right upper extremity, would you again bill 97760 or would you use 97763 for this situation?
Thank you for your thoughts.
We are seeking clarification on this scenario and I will post an updated article on CPT codes 97760, 97761 and 97763 when additional information is available.
Can you clarify initial encounter regarding 97760? If had 1 orthotic for right hand and then later (during same episode of care) needs one for the left would this be another 97760 or 97763?
Thank you
We are seeking clarification on this scenario and I will post an updated article on CPT codes 97760, 97761 and 97763 when additional information is available.
If the 97127 code is “I” invalid for Medicare, does that mean that if I try to bill it with a Medicare patient that it will get denied?
That is correct!
If you bill initially for an orthotic using an L-code and pt needs full reforming of orthotic due change in size (edema decrease or increase), do you charge 97760 for adjustment even though not initial encounter with this orthotic? Having hard time finding clear definition of new 97763 “subsequent” encounter. Thanks
If you had not yet billed 97760 for this episode of care, my OPINION would be 97760 for the first encounter where you are providing any orthotic management and/or training.
Are we able to get clarification on this information my boss obtained at your seminar, but I would like to make sure I understand it fully on how to make sure it is billed correctly…
97532-devel of cog skills- will be d/c end of 2017 and replaced with 97127-
97127 is untimed so bill 1 unit per day; CMS will not pay for it-status “I”- G0515 will need new G code that must be added to it-
do we need to bill 97127 but with correct G-codes OR is the G0515 the new code we should bill instead of 97532?
For the Medicare program, you will need to use G0515 for cognitive training in 2018.
Wanted to clarify that G0515 will remain a timed charge like 97532?
Yes, it will be timed in 15-minute increments.
Thank you for this info, it’s very helpful
Am I correct that Medicare not reimbursing for 97763?
You are not correct. The Medicare program will pay for CPT code 97763 in 2018.
I also cannot get 97763 paid for 2018 claim? did you work this out Melissa Powelson?
You would have to review the EOB to see whey the insurance carrier is not paying for CPT code 97763 and then address the issue with the insurance carrier.
Can you bill any other CPT codes in conjunction with 97763 on the same visit?
You want to checkout the current version of NCCI edits at http://gawendaseminars.com/medicare-cms-cci-edits/
Rick,
Will Medicare Advantage plans (part A and part B) also require Cognitive Skills Development interventions be reported/billed as G0515?
What about private/commercial insurers?
You will need to check with each insurance carrier as to what CPT code they will require and pay for if providing cognitive function interventions.
Can I bill 97760 in addition to the L code for a custom orthosis?
Training is not included in the payment for the L code and would be billed separately under CPT code 97760 if it’s the initial orthotic encounter. What an insurance carrier pays for when billed on the same day is a different story and it would be your responsibility to find that out.
We have two patients that carried over from 2017 that we billed the 97763 for last week. My clearinghouse is not allowing this code to go through because it states it is “invalid in professional service.”
Since this is a new year does the 97760 have to be billed prior to 97763? Or is this an issue I need to take up with the clearinghouse?
In my opinion, an issue you would have to take up with your clearinghouse.
Rick,
Thank you for the description regarding the code changes above. Wanting to clarify if we are working with a patient who has a prosthetic, we bill the 97761 initially and 97763 for follow up prosthetic training, we understand that. However, if you are working on gait primarily, high level balance, stairs functional activities etc. would we bill the 97763 or instead neuro/gait etc? Thank you for any information you can provide. Jen
If working on gait training with the prosthesis on, the appropriate CPT code to bill is 97116 (Gait Training).
For deleted code 29582, what would be the replacement for the application of multi-layer compression for the full leg?
You would use CPT code 29581.
We are a DME Provider. I fit for Breast Prosthesis, some of which are custom. Can I bill the code 97763 or are only certain provider types (physicians/rehab therapists) allowed to bill for that?
For Medicare, you would have to be a qualified provider that can provide therapy services to bill and be paid for CPT code 97763. Regarding all other insurance carriers, you would need to check with them.