2018 Guide to Orthotic and Prosthetic Billing

patient collections in physical therapy

In a recent webinar our CEO John Wallace held for clients concerning coding changes for 2018 he reviewed the changes to the orthotic and prosthetic CPT codes. I’ve taken the information in that webinar and combined it with other coding training materials John created for our clients and give you a complete guide for orthotic and prosthetic billing in 2018 for physical therapy.

97760- Orthotics Initial Encounter Code Description

97760 is orthotics management and training (includes assessment and fitting when not otherwise reported) upper extremity(ies), lower extremity(ies), and or trunk, initial orthotic(s) encounter, each 15 minutes.

If you’re a therapist who sees a lot of orthotic patients you may or may not caught the change in the 2018 code description. It’s only three words, but these three words make a big difference in how you bill. I’ll give you a hint, they’re in bold print. You got it, 97760 now should only be used for the initial orthotic encounter when previously this code could be used for subsequent visits as well.

97760 should only be used when “L-Codes” are NOT used because L-Codes cover all assessment, casting, fabrication time, as well as instructions in use, wearing, and application of the device. If you unfamiliar with what an “L-Code” is, we’ll get to those later in this article.

97761- Prosthetic Initial Encounter Code Description

97761 is prosthetic(s) training, upper and or lower extremity(ies), initial prosthetic(s) encounter, each 15-minutes. Use this code for all interventions or instructions related to prosthetics including:

  • Walking for LE amputees, ADLs for UE and LE amputees
  • Donning and doffing activities
  • Residual limb management activities
  • Self-care related to prosthesis

Like 97760, “initial encounter” has also been added to the descriptor of 97761.

97762 is out. 97763 is in.

97762 “checkout for orthotic/prosthetic use” which was previously used as the “re-eval” for orthotic and prosthetic patients has been deleted and replaced with 97763

97763- Orthotic and Prosthetic Management Description

97763 is Orthotic(s) and Prosthetic(s) Management and or training, upper extremity(ies), lower extremity(ies), and or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15-minutes.

It includes all the same activities and intervention described by the initial encounter (97760 & 97761) but done in the subsequent visit.

L-Codes- Splinting and Bracing

As I mentioned previously you should never bill 97760 or 97761 with L-Codes. L-Codes are HCPCS (Healthcare Common Procedure Coding System) codes used to bill custom splints or braces and include all professional services related to the assessment, fabrication, and supplies including all follow-up. In order to bill L-Codes for devices to Medicare you must be a certified DME (Durable Medical Equipment) provider. If you are not a DME provider, here are some tips for billing custom devices to Medicare and private insurance:

  • Medicare- custom or off-the-shelf orthoses
    • Bill 97760 for initial visit to cover assessment, fabrication or selection, and fitting time
    • Bill the patient for supplies or device
    • Bill 97763 for subsequent visits
  • Private and Work Comp custom or off-the-shelf Orthoses
    • Use HCPCS “L-Codes.” These codes include all professional services related to the assessment, fabrication, and supplies-including all follow-up.
    • Do not bill any other orthotic codes for services or supplies the same day as L-Code

So there you have it, your 2018 guide to orthotic and prosthetic billing. If you have more physical therapy billing questions fill out our Contact Us form today.

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