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How to Bill for an Orthotic Evaluation or Assessment

I am receiving many questions regarding what is the proper billing when a patient is referred to either outpatient 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 orthosis required for the patient. First, we need to provide the CPT code and description

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NCCI Edits: Questions and Answers

On June 15, 2020, I published an article where I answered some of the more common questions I receive regarding the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits as they pertain to outpatient physical, occupational and speech therapy services. That article led to additional questions that I will provide answers to in this article. QuestionDoes the Medicare program pay for CPT code 97750 (Physical performance test or measurement) on the same day as a physical therapy or occupational therapy evaluation or reevaluation? Answer QuestionDoes the Medicare program pay for CPT code 97755 (Assistive technology assessment) on the same day

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L Code vs CPT Code 97760: Which One Do I Use?

In last weeks article, I discussed the difference between CPT codes 97760 (orthotic management and training) and 97662 (checkout for orthotic/prosthetic use). In the article, I explained how CPT code 97760 can include the assessment time, custom fitting or custom fabrication time associated with the orthosis, and the fitting of the orthosis to the patient if that time is not reported somewhere else. In this weeks article, I will discuss what the somewhere else is and when a L code may be appropriate to bill for a prefabricated, custom fitted or custom fabricated orthosis. So if you are not counting

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