CPT 97760 refers to orthotic management and training services, including assessment and fitting, for upper and lower extremities and/or trunk. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 97760.
1. What is CPT 97760?
CPT 97760 is a medical billing code used to describe orthotic management and training services provided by healthcare professionals. These services include the assessment, fitting, and training of patients in the use of orthotic devices for upper and lower extremities and/or trunk. Orthotic devices are artificial supports that help improve the function of a body part, and this code is used to bill for the initial encounter of each 15-minute increment of these services.
2. 97760 CPT code description
The official description of CPT code 97760 is: “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.”
The 97760 procedure involves the following steps:
- Assessment of the patient’s impairment of movement or musculoskeletal abnormalities that affect their ability to perform daily activities.
- Development of a treatment plan based on a comprehensive assessment to enhance functional ability.
- Implementation of the orthotic treatment plan, which includes fitting of the orthotic device, patient instructions, and follow-up plans.
- Direct one-on-one patient contact for training and management of the orthotic device.
- Documentation of the services provided, including the time spent on each service.
4. Qualifying circumstances
Patients eligible to receive CPT code 97760 services are those with impairments of movement or musculoskeletal abnormalities that affect their ability to perform daily activities. These impairments may be due to various conditions, such as injuries, congenital deformities, or diseases that impact the musculoskeletal system. The healthcare provider must determine that the use of an orthotic device is medically necessary and will improve the patient’s functional ability.
5. When to use CPT code 97760
It is appropriate to bill the 97760 CPT code when a healthcare provider is providing initial orthotic management and training services for a patient with upper or lower extremity and/or trunk impairments. This code should be used for each 15-minute increment of the initial encounter for these services. Subsequent encounters should be billed using CPT code 97763.
6. Documentation requirements
To support a claim for CPT 97760, healthcare providers must document the following information:
- A comprehensive assessment of the patient’s impairment and functional limitations.
- A detailed treatment plan outlining the goals and objectives of the orthotic intervention.
- A description of the orthotic device, including its type, fit, and adjustments made during the fitting process.
- Instructions provided to the patient on the use and care of the orthotic device.
- Follow-up plans for monitoring the patient’s progress and adjusting the orthotic device as needed.
- The total time spent on each service, reported in 15-minute increments.
7. Billing guidelines
When billing for CPT code 97760, healthcare providers should keep the following guidelines and rules in mind:
- Report this code for each 15 minutes of the initial training and management encounter and use CPT code 97763 for each 15 minutes of subsequent encounters.
- Do not report CPT code 97760 with CPT code 97116 for the same extremity(ies).
- Ensure that all documentation requirements are met to support the claim for services provided.
8. Historical information
CPT 97760 was added to the Current Procedural Terminology system on January 1, 2006. The code was changed on January 1, 2018, with the previous descriptor being “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.”
9. Similar codes to CPT 97760
Five similar codes to CPT 97760 and how they differentiate are:
- CPT 97761: This code is used for prosthetic training, rather than orthotic training.
- CPT 97762: This code is for checkout for orthotic/prosthetic use, which is a separate service from management and training.
- CPT 97763: This code is used for subsequent encounters of orthotic management and training, rather than the initial encounter.
- CPT 97116: This code is for gait training therapy and should not be reported with CPT 97760 for the same extremity(ies).
- CPT 97530: This code is for therapeutic activities, which are different from orthotic management and training services.
Here are 10 detailed examples of CPT code 97760 procedures:
- A patient with a lower extremity amputation receives an ankle-foot orthosis and requires training on its use and care.
- A patient with a spinal deformity is fitted with a thoracolumbosacral orthosis and receives instructions on how to wear and adjust the device.
- A patient with carpal tunnel syndrome is provided with a wrist-hand orthosis and trained on its proper use to alleviate symptoms.
- A patient with a foot drop due to a neurological condition is fitted with an ankle-foot orthosis and receives training on its use and maintenance.
- A patient with a knee injury is provided with a knee orthosis and instructed on its proper use and care to aid in recovery.
- A patient with a congenital upper extremity deformity is fitted with an elbow orthosis and receives training on its use and adjustment.
- A patient with a hip injury is provided with a hip orthosis and instructed on its proper use and care to aid in recovery.
- A patient with a shoulder injury is fitted with a shoulder orthosis and receives training on its use and maintenance.
- A patient with a cervical spine injury is provided with a cervical orthosis and instructed on its proper use and care to aid in recovery.
- A patient with a lower extremity deformity is fitted with a knee-ankle-foot orthosis and receives training on its use and adjustment.