With detailed and specific codes, podiatry coding is a challenging process. Any mistake in selecting codes can lead to claim denials and thus reimbursement issues. The key to billing for orthotics lies in correct verification of the patient’s insurance coverage for durable medical equipment (DME). The CPT codes used for reporting orthotic and prosthetic management and training services were revised by differentiating between initial and subsequent encounters.
CPT codes
- 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.
(CPT code 97760 – the fitting of the functional orthotics, training in use, care and wearing time of the functional orthotics and brief instructions in exercises while the functional orthotics are in place. Specifically, this code refers to the initial encounter).
- 97761 – Prosthetic(s) training, upper and/or lower extremity (ies), initial prosthetic(s) encounter, each 15 minutes.
(Healthcare providers need to use this CPT code for any prosthetics-related instructions or interventions, including – ADLs for UE and LE amputees, donning and doffing activities, walking for LE amputees, residual limb management, and prosthesis-related self care. This code applies only to the initial encounter).
- 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.
(Providers must use CPT codes 97760 and 97761 only for initial encounters. CPT code 97763 – includes the same activities described by the other two codes, but is specifically reserved for subsequent encounters for modifications, fitting adjustments, and additional training regardless of whether the orthotic is custom made or prefabricated).