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Orthotic management and training involve the use of specialized devices designed to modify the structural and functional characteristics of the skeletal and neuromuscular systems. These devices, known as orthotics, are externally applied and tailored to meet the individual needs of patients based on their unique anatomy, physiology, and specific medical conditions. The primary purpose of orthotics is to enhance mobility, provide support, and alleviate pain by controlling movement, stabilizing gait, and correcting deformities. This can be particularly beneficial for individuals recovering from trauma, neurological impairments, or other conditions that affect their ability to function normally. The initial encounter for orthotic management, as represented by CPT® Code 97760, encompasses not only the assessment and fitting of the orthotic device but also the training of the patient or caregiver in its proper use. This training may include guidance on exercises to be performed while using the orthotic, instructions on skin care, and recommendations for appropriate wearing times. Additionally, the clinician evaluates the effectiveness of the orthotic in addressing the specific issues for which it was prescribed. It is important to note that the costs associated with the orthotic device itself, including materials and supplies, are billed separately from the management and training services provided under this code.
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The indications for orthotic management and training using CPT® Code 97760 include a variety of conditions and symptoms that necessitate the use of orthotic devices. These may encompass:
The procedure for orthotic management and training involves several key steps, each critical to ensuring the effective use of the orthotic device. These steps include:
Post-procedure care following orthotic management and training is essential for ensuring the continued effectiveness of the orthotic device. Patients are advised to follow specific guidelines regarding the use of the orthotic, including recommended wearing times and activities. Regular follow-up appointments may be scheduled to assess the fit and function of the orthotic, make adjustments as needed, and address any concerns related to skin integrity or comfort. Additionally, ongoing training may be provided to reinforce the skills learned during the initial encounter, ensuring that the patient or caregiver is confident in using the orthotic device effectively. It is crucial for patients to communicate any issues or discomfort experienced while using the orthotic to their healthcare provider promptly.
| Short Descr | ORTHOTIC MGMT&TRAING 1ST ENC | Medium Descr | ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS | Long Descr | 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 | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 7 - Physical Therapy Service, for which Payment may not be Made | Multiple Procedures (51) | 5 - Special payment adjustment rules on the RVU practice expense component of multiple therapy service applies... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M5D - Specialist - other | MUE | 6 | CCS Clinical Classification | 215 - Other physical therapy and rehabilitation |
| GO | Services delivered under an outpatient occupational therapy plan of care | GP | Services delivered under an outpatient physical therapy plan of care | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | KX | Requirements specified in the medical policy have been met | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | CO | Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | CR | Catastrophe/disaster related | LT | Left side (used to identify procedures performed on the left side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GC | This service has been performed in part by a resident under the direction of a teaching physician | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | F5 | Right hand, thumb | F8 | Right hand, fourth digit | GA | Waiver of liability statement issued as required by payer policy, individual case | GF | Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital | GN | Services delivered under an outpatient speech language pathology plan of care | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GX | Notice of liability issued, voluntary under payer policy | GZ | Item or service expected to be denied as not reasonable and necessary | HA | Child/adolescent program | NU | New equipment | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | U5 | Medicaid level of care 5, as defined by each state | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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Notes
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| 2018-01-01 | Changed | Long medium and short descriptions changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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