With the implementation of the new physical and occupational therapy evaluation codes with dates of service on and after January 1, 2017, I am receiving many questions what do I think is the proper billing when a patient is referred to either physical therapy or occupational therapy for the purpose of an orthosis. In this article, I will answer this question from 2 perspectives. I will first address when a patient is referred for a one-time visit for an orthosis and secondly, provide the answer for when a full evaluation is required to develop the appropriate treatment plan in addition to an assessment related to determining the specific orthotic.
First, we need to provide the CPT code and description for orthotic management and training. Per the American Medical Association (AMA), CPT Professional Edition, 2017, CPT code 97760 is defined as follows: “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”. In the February 2007 edition of CPT Assistant, the AMA further states
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.