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Orthotic and prosthetic management involves the use of specialized devices designed to support or replace the function of limbs or body segments. Orthotics are external devices that modify the structural and functional characteristics of the skeletal and neuromuscular systems, while prosthetics refer to artificial limbs that replace missing body parts. These devices are tailored to the individual’s unique anatomical and physiological needs, taking into account factors such as biomechanics and engineering principles. Prostheses can vary in type, including cosmetic (passive) options, body-powered devices that utilize cables, and advanced electronically powered prosthetics that are controlled by myoelectric sensors or switches. Orthotic devices serve various purposes, such as enhancing mobility, restricting movement, reducing weight-bearing forces, and correcting deformities to alleviate pain and improve function. For instance, upper limb orthotics may be employed to restore function after trauma or neurological impairments, while lower extremity orthotics are primarily used to stabilize gait and correct deformities. Additionally, spinal or trunk orthotics are designed to address skeletal curvatures or aid in recovery following surgical procedures or injuries. The management and training associated with these devices are critical for ensuring that patients can effectively use them, which is reflected in the coding for subsequent encounters, such as CPT® Code 97763, which accounts for each 15-minute session of orthotic or prosthetic management and training.
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The procedure associated with CPT® Code 97763 is indicated for patients who require ongoing management and training related to their orthotic or prosthetic devices. This may include individuals recovering from trauma, surgery, or neurological impairments that affect their mobility and function. Specific indications for this procedure may include:
The procedure for CPT® Code 97763 involves several key steps that ensure effective management and training for patients using orthotic or prosthetic devices. Each step is crucial for maximizing the benefits of the devices and ensuring patient safety and comfort.
After the procedure associated with CPT® Code 97763, patients are expected to continue practicing the skills learned during their training sessions. Ongoing follow-up appointments may be necessary to monitor the patient’s adaptation to the orthotic or prosthetic device, assess any changes in their condition, and make further adjustments as needed. Patients should be encouraged to communicate any discomfort or challenges they experience while using the device, as this feedback is essential for optimizing their rehabilitation process. Additionally, education on skin care, proper usage, and maintenance of the device is critical to prevent complications and ensure long-term success in using the orthotic or prosthetic device.
| Short Descr | ORTHC/PROSTC MGMT SBSQ ENC | Medium Descr | ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN | Long Descr | 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 | 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) | none | MUE | 6 |
| GO | Services delivered under an outpatient occupational therapy plan of care | GP | Services delivered under an outpatient physical therapy plan of care | KX | Requirements specified in the medical policy have been met | 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. | 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 | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | 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. | 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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 | 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 | GW | Service not related to the hospice patient's terminal condition | 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) | 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | CG | Policy criteria applied | F1 | Left hand, second digit | F2 | Left hand, third digit | F3 | Left hand, fourth digit | F4 | Left hand, fifth digit | F8 | Right hand, fourth digit | F9 | Right hand, fifth digit | GN | Services delivered under an outpatient speech language pathology plan of care | GQ | Via asynchronous telecommunications system | 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 | KK | Dmepos item subject to dmepos competitive bidding program number 2 | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2018-01-01 | Added | Code Added. |
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