CPT 97760 and CPT 97761 are intended only to be reported for the initial encounter with the patient and can be billed if an orthotic is fabricated. CPT 97763 can be billed used for all subsequent encounters for modifications, fitting adjustments, and additional training regardless of whether the orthotic is custom made or prefabricated.
CPT Codes For Orthotic Management & Training And Prosthetic Management
Description of CPT 97763: 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.
Description of CPT 97761: (Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes)
Description of CPT 97760: (Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes).
Description of CPT G0515: Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
CPT 97763 is designated as “always therapy” and must always be reported with the appropriate therapy GN modifier, GO Modifier or GP modifier, to indicate whether it’s under a Speech-language pathology (SLP), Occupational Therapy (OT) or Physical Therapy (PT) plan of care, respectively.
CPT G0515 is designated as a “sometimes therapy” code, which means that an appropriate therapy GN modifier, GO Modifier or GP modifier, to reflect it’s under an SLP, OT, or PT plan of care – is always required when this service is furnished by therapists; and, when it’s furnished by or incident to physicians and certain Nonphysician Practitioners (NPPs), that is, nurse practitioners, physician assistants, and clinical nurse specialists when the services are integral to an SLP, OT, or PT plan of care.