Orthotics

Select the CPT® code that represents the occupational therapy services you're providing.

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.

97761

Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes.

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.

Supplies can be billed with 97760 and 97761 if an orthotic is fabricated. If also billing an L code for the orthotic, 97760 and 97761 should only be used when training is completed and training alone exceeds 8 minutes.

97763 should be used for all subsequent encounters for modifications, fitting adjustments, and additional training regardless of whether the orthotic is custom made or prefabricated.

Remember, these are time-based codes. More than one unit can be billed based on the amount of time spent face to face with the client. Also, these services must be properly documented to include not only time spent but also:

• what was fabricated, adjusted, or trained
• the reason for the fabrication, adjustment, or training
• activities or exercises performed in the orthotic
• a description of the client’s condition
• the client’s response

Orthotic management cannot be billed on the same day as an evaluation. It can be used for the fabrication of a custom splint. Supplies can be billed in addition to the management code. If you choose to use HCPCS L codes to bill for the orthotic, you cannot bill for orthotic management.

If the orthotic is not fabricated on site, it will most likely have an appropriate L code for billing. Some practitioners will send the client to a supplier who will bill Medicare directly for the orthotic. Others may choose to keep a supply of these orthotics in the therapy clinic and bill Medicare when they are dispensed.

For any DMEPOS item to be covered by Medicare, the patient’s medical record must contain sufficient information about the patient’s medical condition to substantiate the necessity of the type and quantity of items ordered, and for the frequency of use or replacement (if applicable). The information should include the patient’s diagnosis and other pertinent information as applicable, such as:

• duration of the patient’s condition
• clinical course (worsening or improving)
• prognosis, nature, and extent of functional limitation
• other therapeutic interventions and results
• past experience with related items.

Selected HCPCS Level II codes

Frequently asked questions about billing for orthotics

• Coding & Billing