How To Use CPT Code 97761

CPT 97761 describes the initial prosthetic(s) encounter for upper and/or lower extremity(ies) and involves prosthetic training and management. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 97761?

CPT 97761 can be used to describe the initial encounter for prosthetic training and management for upper and/or lower extremities. This code is used when a prosthetist, who is specifically trained and educated in comprehensive prosthetic patient care, assesses patients with movement impairments or musculoskeletal abnormalities that affect their daily activities. The prosthetist develops a treatment plan based on a comprehensive assessment to enhance functional ability and implements the prosthetic treatment plan, including demonstrating and describing the prosthetic recommendation, fitting criteria, patient instructions, and follow-up plans.

2. Official Description

The official description of CPT code 97761 is: ‘Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes.’

3. Procedure

1. The prosthetist assesses the patient’s impairment of human movement or musculoskeletal abnormalities that affect their ability to perform daily activities.
2. A comprehensive treatment plan is developed based on the assessment to enhance the patient’s functional ability.
3. The prosthetist demonstrates and describes the prosthetic recommendation, fitting criteria, patient instructions, and follow-up plans.
4. The prosthetist provides training and management in the use of the prosthetic(s) for each 15-minute encounter.
5. Additional encounters may be scheduled as needed to ensure the patient’s successful adaptation to the prosthetic(s).

4. Qualifying circumstances

Patients eligible to receive CPT 97761 services are those with impairments of human movement or musculoskeletal abnormalities that affect their ability to perform daily activities. The prosthetic training and management must be provided by a prosthetist who is specifically trained and educated in comprehensive prosthetic patient care. Each encounter is billed for each 15 minutes of the initial prosthetic(s) encounter.

5. When to use CPT code 97761

CPT code 97761 should be used for the initial encounter of prosthetic training and management for upper and/or lower extremities. It should be reported for each 15 minutes of the initial encounter. Subsequent encounters should be reported using CPT code 97763.

6. Documentation requirements

To support a claim for CPT 97761, the prosthetist must document the following information:

• Patient’s impairment of human movement or musculoskeletal abnormalities
• Comprehensive assessment and treatment plan
• Description of the prosthetic recommendation, fitting criteria, patient instructions, and follow-up plans
• Date, start and end time of each 15-minute encounter
• Training and management provided during each encounter
• Progress made by the patient and any additional encounters scheduled
• Signature of the prosthetist providing the service

7. Billing guidelines

When billing for CPT 97761, ensure that the service is provided by a prosthetist who is specifically trained and educated in comprehensive prosthetic patient care. Each 15-minute encounter should be reported separately. Do not report CPT code 97761 for subsequent encounters; use CPT code 97763 instead. Follow any additional guidelines provided by the payer for accurate billing and reimbursement.

8. Historical information

CPT 97761 was added to the Current Procedural Terminology system on January 1, 2006. The code underwent a change on January 1, 2018, where the description was modified to ‘Prosthetic training, upper and/or lower extremity(s), each 15 minutes.’

9. Examples

1. A prosthetist providing an initial encounter for upper extremity prosthetic training and management for a patient with limb loss.
2. A prosthetist assessing a patient with musculoskeletal abnormalities affecting their lower extremities and developing a treatment plan for prosthetic training and management.
3. A prosthetist demonstrating and describing a prosthetic recommendation, fitting criteria, and patient instructions during an initial encounter for lower extremity prosthetic training and management.
4. A prosthetist providing training and management in the use of a prosthetic arm during an initial encounter for upper extremity prosthetic training.
5. A prosthetist scheduling additional encounters to ensure the successful adaptation of a patient to their lower extremity prosthetic(s).
6. A prosthetist documenting the progress made by a patient during an initial encounter for upper and lower extremity prosthetic training and management.
7. A prosthetist providing an initial encounter for upper extremity prosthetic training and management for a patient with congenital limb deficiency.
8. A prosthetist developing a comprehensive treatment plan for a patient with movement impairments affecting their lower extremities and implementing prosthetic training and management during an initial encounter.
9. A prosthetist providing training and management in the use of a prosthetic leg during an initial encounter for lower extremity prosthetic training.
10. A prosthetist scheduling follow-up plans and additional encounters to ensure the successful adaptation of a patient to their upper extremity prosthetic(s).