For those of you that work with patient’s who have had a lower and/or upper extremity amputation and now must be fitted and trained in the use of a prosthesis, we do not fully understand what interventions, training and education we provide that are included as part of prosthetic training (CPT codes 97761 and 97763). In this article, I will teach you what services and interventions you provide are included in prosthetic training and provide you with a critical reference to support my answer that you will want to have at your disposal to educate insurance carriers and/or to use to support your billing of prosthetic training if being audited or reviewed by an insurance carrier.
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Per the American Medical Association (AMA), CPT code 97761 is defined as “Prosthetic training, upper and/or lower extremities, initial prosthetic encounter, each 15 minutes”. CPT code 97763 is defined as “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”.
So what services provided under a physical or occupational therapy plan of care would be considered prosthetic training and billed under 97761 for the initial prosthetic encounter or 97763 for the subsequent prosthetic encounter?
According to the AMA