BeckyD23
New
Does anyone have issues in getting CPT 97760 paid when billed with orthoses when fitting and adjustment is not included already in the orthotic? Should CPT 97760 be billed with an off the shelf orthotic to represent training such as a wearing schedule, placing and removing the orthosis, skin care, etc.? Or is this code only billable if fitting/adjustment or training is beyond what is included in the customized orthotic? The following from DMEMAC:
The L codes for orthotics provide a brief description of the device and describe whether the device needs to be molded to a patient model, custom fabricated, custom fitted, or have no fitting specifications. Select the appropriate L code based on the description of the brace provided.
The Medicare payment for the L codes includes the following items.
To avoid duplicate billing, the time spent assessing, measuring and/or fitting, fabricating or modifying, or making the orthotic may not be included in calculating the number of units to bill for CPT 97760 when also billing the appropriate L code. CPT 97760 is a "timed" code and only minutes actually spent in the training of the patient should be counted when determining units to bill when an L code is also billed.
Billing and Coding: Outpatient Physical and Occupational Therapy Services:
Coverage under CPT code 97760 is not for prefabricated/commercial (i.e., off the shelf) components such as, but not limited to a lumbar roll, non-customized foam supports/wedges (e.g., heel cushions), or multi-podus boots. Such components do not require the skills of a therapist and are non-covered. Minor modifications to prefabricated orthotics do not constitute a customized orthotic.The L codes for orthotics provide a brief description of the device and describe whether the device needs to be molded to a patient model, custom fabricated, custom fitted, or have no fitting specifications. Select the appropriate L code based on the description of the brace provided.
The Medicare payment for the L codes includes the following items.
- Assessment of the patient regarding the orthotic
- Measurement and/or fitting
- Supplies to fabricate or modify the orthotic
- Time associated with making the orthotic
To avoid duplicate billing, the time spent assessing, measuring and/or fitting, fabricating or modifying, or making the orthotic may not be included in calculating the number of units to bill for CPT 97760 when also billing the appropriate L code. CPT 97760 is a "timed" code and only minutes actually spent in the training of the patient should be counted when determining units to bill when an L code is also billed.