CPT-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”

CODE TYPE

Timed based code
Billed in 15 minutes increment

ADD-ON CODE

No add-on code

ORTHOTICS AND PROSTHETIC TRAINING

This CPT is used at the subsequent encounter after the initial encounter, the provider meets face–to–face with the patient to manage or train the patient on the use of an upper or lower extremity or trunk orthotic or prosthetic device.

CODING GUIDELINES

» Require the professional skills of qualified healthcare professionals that includes:

Physical Therapist
Occupational Therapist
Chiropractors
Physical Therapist Assistant
Occupational Therapy Assistant

» Billed in 15 minutes increment » Requires a therapy modifier (GP, GN, GO, CO, CQ) » CMS 8-minute rule and AMA rule of Eights are applied

CMS 8-Minute Rule:

A minimum of 8 minutes of direct contact with the patient must be provided for a single unit of 97763 to be billed:

Units	Number of Minutes
1 unit	≥ 08 minutes through 22 minutes
2 units	≥ 23 minutes through 37 minutes
3 units	≥ 38 minutes through 52 minutes
4 units	≥ 53 minutes through 67 minutes
5 units	≥ 68 minutes through 82 minutes
6 units	≥ 83 minutes through 97 minutes
7 units	≥ 98 minutes through 112 minutes
8 units	≥ 113 minutes through 127 minutes

The pattern remains the same for treatment times of more than 2 hours.

Ama Rule Of Eights:

“AMA guidelines state that incremental intervals of treatment performed on the same session may be added together when determining total time in direct contact of a qualified healthcare provider with the patient is necessary. Each unique timed service is counted separately instead of combining the time from multiple units”

Physical Therapy Modifiers

Below mentioned modifiers are used when services are provided for the respective plan of care:

MODIFIERS	PLAN OF CARE
GP	Outpatient Physical Therapy
GO	Outpatient Occupational Therapy
GN	Outpatient Speech-Language Pathology
CQ	Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially)
CO	Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially)

Total No. Of Billable Units

06 units are allowed per date of service by CMS but more units can be billed if justified by medical notes.

Reimbursement Guidelines

For reimbursement following elements must be documented the Physical Therapy Notes:

Total direct time spent by the provider with the patient as well as total duration of treatment.
Documentation of results of assessment and patient’s functional level.
CPT 97763 does not include cost of material or casting time. It is suggested to confirm specific insurance coding and billing criteria for casting supplies.
Payment made not be made in following conditions:

If physical therapy services are provided to a patient in a hospital outpatient department
If physical therapy services are provided to an inpatient by an independently practicing healthcare provider.

Note: CPT 97763 is used for all subsequent encounters.

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CPT-97763

CATEGORY

CODE TYPE

ADD-ON CODE

ORTHOTICS AND PROSTHETIC TRAINING

CODING GUIDELINES

CMS 8-Minute Rule:

Ama Rule Of Eights:

Physical Therapy Modifiers

Total No. Of Billable Units

Reimbursement Guidelines

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