2025 CPT code 97763
(Active) Effective Date: N/A Revision Date: N/A Rehabilitation - Orthotics and Prosthetics Training Medicine Services and Procedures > Physical Medicine and Rehabilitation Evaluations Feed
Orthotic/prosthetic management and training for upper, lower extremities, or trunk; subsequent encounter, per 15 minutes.
Modifiers may be applicable depending on the circumstances of service.Consult the AMA CPT manual and payer specific guidelines for applicable modifier rules.
Medical necessity is established by documenting the patient's need for skilled therapy to learn to use the orthotic or prosthetic device safely and effectively. This would include demonstration of impairments in functional mobility or ADLs due to the condition requiring the orthotic or prosthetic device.The therapy plan should be tailored to the patient's specific needs and show measurable progress toward functional goals.
The clinical responsibility rests with the qualified healthcare professional (e.g., physical therapist, occupational therapist) who provides the face-to-face management and training of the patient in orthotic or prosthetic use. This includes assessment, treatment planning, device fitting/refitting, instruction, and follow-up.
- Medicine Services and Procedures > Physical Medicine and Rehabilitation Evaluations
- Physical Medicine and Rehabilitation
In simple words: This code covers the time a therapist spends with a patient after the initial visit to help them learn how to use an orthotic (a brace or support) or a prosthetic (an artificial limb or body part).The therapist works directly with the patient for 15-minute periods, teaching them how to use the device and helping them adjust to it.
This CPT code reports subsequent (following an initial encounter) face-to-face time spent by a qualified healthcare professional managing and training a patient in the use of an orthotic or prosthetic device for the upper and/or lower extremities and/or trunk.The code represents each 15-minute interval of direct patient contact.The services include assessment of movement impairment, treatment planning to enhance functional ability, device fitting or refitting, patient instruction, and follow-up planning.This code should not be used in conjunction with codes 97760 or 97761.Always use the appropriate therapy modifier (GN, GO, or GP) to indicate if the service is under a Speech-language pathology, Occupational Therapy, or Physical Therapy plan of care, respectively.
Example 1: A patient received a custom-fabricated knee orthosis following a total knee arthroplasty.The physical therapist uses code 97763 to bill for subsequent visits where the patient receives instruction on donning/doffing, gait training with the orthosis, and exercises to improve knee mobility and strength.Three 15-minute sessions were provided., A patient has been fitted with a below-elbow prosthesis following an amputation.The occupational therapist uses code 97763 to bill for 45 minutes of subsequent training sessions during which the patient practices functional activities like eating, writing, and dressing with the prosthesis.Three units of 97763 are reported., A patient received a prefabricated wrist orthosis for carpal tunnel syndrome. The occupational therapist performed a 30-minute session fitting the orthosis, adjusting straps, and teaching the patient proper use.Two units of 97763 are billed.
Detailed documentation is crucial, including: the date of service; the type of orthotic/prosthetic device; the specific training provided; the duration of each 15-minute interval; the patient's progress; and the patient's response to the treatment.Notes should also include the therapist's assessment of the patient's functional limitations and goals of therapy.
** The "always therapy" designation requires the use of a therapy modifier (GN, GO, GP) regardless of the provider type.Always verify payer-specific guidelines for billing and reimbursement.
- Revenue Code: M5D (Specialist - Other)
- RVU: Not specified in provided data.RVUs vary by payer and geographic location.
- Global Days: Not applicable; this is a time-based code, not a procedure with a global period.
- Payment Status: Active
- Modifier TC rule: Not applicable;this is a professional service code.
- Fee Schedule: Fee schedules vary by payer and location.Refer to specific payer fee schedules for historical information.
- Specialties:Physical Therapy, Occupational Therapy
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Rehabilitation Facility, Other Place of Service (depending on the setting of care)