Two of the most confusing CPT codes that therapists and assistants ask me questions on, whether during a live seminar, a webinar, or just in an email question is, what is the difference between CPT code 97760 (orthotic management and training) and CPT code 97762 (checkout for orthotic/prosthetic fit) and what interventions would be included in each CPT code? Before I answer the question, let me provide the full CPT code description of each CPT code.
97760 – Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes.
97762 – Checkout for orthotic/prosthetic use, established patient, each 15 minutes
So to answer the question of what interventions fall under each CPT code and when to use each CPT code. Lets discuss CPT code 97760 first. The interventions that are included under CPT code 97760 is the
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What if this was the patient’s first visit? Are we allowed to bill CPT code 97760 along with a 97001? Or, does CPT code 97760 take the place of 97001 and we bill the appropriate units reflecting the time spent with the patient?
That question will be addressed in next weeks article.
Are we able to bill eval code 97161 and 96660 (orthosis fit and train at initial encounter) if an eval was performed and adjusting the fit of a previously issued custom orthosis was completed (in state of NC)?
Please check the current version of NCCI edits as well as the 2020 NCCI Policy Manual that is available to you as a Gold Member to my website.
Is a G code required when billing Medicare either the 97760 or 97762 code? The patient may not have been referred for an evaluation only issued an orthotic and then the patient returns for splint check/adjustment down the line. Thanks.
If you billed an L code the first visit and no CPT codes, functional limitation reporting is not required. If the Medicare patient returns for a second visit and you now bill a therapy CPT code that does require functional limitation reporting (i.e. 97760 or 97762), then functional limitation reporting would be required on that visit.
97662 is listed in the CCI edits. Am looking for description of the code. The article describes 97762 but states difference between 97760 and 97662. Is 97662 a valid code? What is description? Thanks!
97762 is listed in the article. 97762 is a valid CPT code and the description is listed in the article.
Does CPT code 9770 or an Lcode cover the actual orthotic (i.e. DME) itself? We have an outside vendor fabricate our orthotic from our cast impressions. It has been difficult to cover our cost to the outside vendor as well as our clinical time. Is there another way to collect for the actual orthotic?
Here 2 articles that will help you.
If a vendor is billing the L code, then you are doing the work for them.
if you initially billed the patient 97760 for the first time you saw the patient, but the patient needed modification to the orthotic sometime if the future, would you bill a 97762, or is it appropriate to bill another 97760 if the modification requires further assessment? I am confused on whether to bill 97760 or 97762 for follow up on that orthotic. thanks,
Modification of an orthosis would be under CPT code 97760.
If you billed an L code the first visit and no CPT codes, functional limitation reporting is not required. If the Medicare patient returns for a second visit and you now bill a therapy CPT code that does require functional limitation reporting (i.e. 97760 or 97762), then functional limitation reporting would be required on that visit….My question – Do you not have to perform an evaluation for G-codes?
You do not; however, if you do perform an evaluation and bill the evaluation CPT code, functional limitation reporting is required.
Is there a maximum # of units you can bill 97760 or 97762 in 1 treatment session? For instance, if 1 spend 90 minutes working on orthotic training, can I bill 6 units of 97760 in 1 day, or do I have to limit my time to a max # of units/day?
You would have to check with the insurance carrier to see if there are limits on how many units they will pay for on a certain CPT code and/or limits on how many units they will allow per visit.
If i fabricate a splint and also adjust a different splint previously made, am I able to bill 97760 and 97762?
We must first call them orthotics as that is what we are providing and modifying. The modification of an orthosis would be included under CPT code 97760 in 2017 and not under CPT code 97762.
Per a CMS 2018 annual update to the therapy code list: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10303.pdf
It states that the codes have now been changed. 97760 for initial encounter orthotics, and 97761 for initial encounter prosthetics; that 97762 has been deleted and replaced with 97763 for all subsequent encounters. So have you gotten rid of 97762 in your practice?
You would have wanted to have read this article here that describes the changes that occurred on January 1, 2018.