2025 CPT code 97760
(Active) Effective Date: N/A Revision Date: N/A Physical Medicine and Rehabilitation - Orthotic management Medicine Services and Procedures > Physical Medicine and Rehabilitation Evaluations Feed
Orthotic management and training, including assessment and fitting (when not otherwise reported), for upper, lower extremities, and/or trunk; initial encounter, per 15 minutes.
Modifiers 59 (distinct procedural service) or 79 (unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) may be used when appropriate.Carefully refer to the specific circumstances to use these modifiers accurately.
Medical necessity is established when the orthotic device is required to improve the patient's functional ability due to an underlying condition causing movement impairment or musculoskeletal abnormalities affecting daily living activities. Supporting documentation should link the need for the orthotic to the patient's diagnosed condition and the impact it has on their functioning.
The clinical responsibility lies with the physical or occupational therapist who provides direct one-on-one patient education, assessment, fitting and adjustment of the orthotic device.
- Medicine Services and Procedures > Physical Medicine and Rehabilitation Evaluations
- Physical Medicine and Rehabilitation
In simple words: This code covers the time a therapist spends teaching you how to use a brace or support (orthotic) for your arm, leg, or torso. The therapist helps you put it on, shows you how to use it, and makes sure it fits correctly. This is billed for each 15 minutes of the first session.
This CPT code reports orthotic management and training, encompassing assessment, fitting, and instruction on using orthotics for upper and/or lower extremities and/or the trunk.The service includes direct one-on-one patient contact.It is billed in 15-minute increments for the initial encounter.Assessment focuses on movement impairment or musculoskeletal abnormalities affecting daily activities. A treatment plan is developed based on a comprehensive assessment to improve functional ability. The plan's implementation involves fitting the orthotic device, providing patient instructions, and outlining follow-up plans.Note: Code 97760 should not be reported with 97116 for the same extremity(ies).
Example 1: A patient with a recent wrist fracture is seen for initial fitting and instruction on using a custom wrist splint. The therapist spends 30 minutes (2 units of 97760) instructing the patient on proper splint application, removal, hygiene, and activity modification., A patient with bilateral knee osteoarthritis receives instruction on using knee braces. The therapist spends 45 minutes (3 units of 97760) assessing gait, fitting the braces, and educating the patient on appropriate brace use and activities., A patient with cerebral palsy requires training on the use of a custom trunk orthosis. The initial fitting and training session lasts 60 minutes (4 units of 97760), covering assessment, fitting, adjustment, and patient education on proper application and care.
Detailed documentation should include:* Patient's diagnosis and functional limitations.* Type of orthotic device used.* Time spent in assessment, fitting, and training.* Specific instructions given to the patient.* Follow-up plan, if applicable.* Progress notes reflecting patient's ability to use the orthosis.
** This code is used for initial orthotic management and training. For subsequent encounters, use code 97763.Billing for this service typically requires a plan of care from a qualified therapist (PT or OT).
- Revenue Code: M5D (SPECIALIST - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Physical Therapy, Occupational Therapy
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, Inpatient Hospital (if part of inpatient rehab program)