Essentials of CPT Code 97750 in Orthotics and Rehabilitation

In medical billing and coding, CPT, or Current Procedural Terminology, is an important element for properly identifying the specific services that a healthcare professional offers by executing particular processes. The procedure further helps outline those healthcare services accurately communicated for insurance payment reimbursements. One frequently used example is CPT Code 97750 in rehabilitation therapy, physical therapy, and healthcare practices.

In this blog, we will explain in detail what CPT Code 97750 is, what it represents, when it is used, and its relevance in the medical billing and coding process. We will also discuss its importance in physical therapy, rehabilitation, and other specialties that often bill using this code.

What is CPT Code 97750?

CPT code 97750 will be identified by “Physical Medicine and Rehabilitation (PM&R)-Orthotic Management and Training, one or more areas. This applies when orthotic management involves either fitting and adjusting or even simply training used by the prescriber, which consists of applying those things to align deformities within an individual musculoskeletal area by an orthopedist.

Orthotics can range from splints, braces, and shoe inserts to custom-designed devices to improve the function of a joint or limb. When a healthcare provider fits or trains a patient to use an orthotic device, they use CPT Code 97750 to bill for the service.

This code specifically includes the assessment and management of orthotic devices and the training provided to patients to use these devices effectively. The procedure can involve several stages, such as:

• Evaluation of the need for an orthotic device
• Fitting and adjustments of the orthotic device
• Patient education on how to use the device properly
• Training in activities that may be facilitated or supported by the orthotic device

When is CPT Code 97750 Used?

Specifically, there are some cases where the need for orthotic management applies to CPT Code 97750. These cases include the following:

• Orthotic fitting and adjustments: When a physician fits a patient with an orthotic device, whether it be a brace, splint, or custom shoe insert, CPT Code 97750 describes the service. This could include adjustments to fit the patient’s needs or anatomical considerations.
• Orthotic Training: Besides fitting the device, healthcare providers usually train patients on the proper usage of orthotics. This includes wear, maintenance, and specific activities or exercises that may be done during device usage.
• Orthotic Management: Some patients may require scheduled adjustments or follow-ups to check the effectiveness of the orthotic device. In addition, follow-up may be reimbursed by using CPT Code 97750 in cases wherein it would include re-evaluation, revision, or education on the use of the orthotic device.
• Chronic conditions or injury: A patient suffering from chronic conditions such as arthritis recovering from an injury (like sprain, fracture, or surgery) might require orthotics for better mobility, for the protection of the injured region, or for alleviating pain. Applying this CPT code allows the provider to collect a fee for the management and training using the orthotic.
• Rehabilitation and Physical Therapy: When orthotics are a part of rehabilitation in physical therapy settings, CPT Code 97750 can be applied. Thus, after a stroke or after an orthopedic surgery, a physical therapist could prescribe an orthotic device to help restore function; the sessions might include training on using such a device.

What does CPT Code 97750 Cover?

CPT Code 97750 includes various aspects of orthotic management and training. The primary components include:

• Evaluation: This part is comprised of assessing the patient’s need for an orthotic device, identifying the specific body area that requires support or correction, and determining the type of orthotic device best suited for the patient’s condition.
• Fitting and Adjustment: Following the selection of the appropriate orthotic device, the healthcare provider will fit the device and make any necessary adjustments to ensure comfort and functionality for the patient. This includes fitting custom devices for the best possible support and alignment.
• Patient Education: Educating the patient on the proper use and care of the orthotic device is a critical aspect of CPT Code 97750. The healthcare provider will demonstrate how to wear the device correctly, how to maintain it, and any specific activities or exercises that should be performed while using the device.
• Orthotic Use Training: Patients may require training on moving, walking, or performing daily activities with the orthotic device. For instance, leg or foot orthotics patients may need training to walk properly or avoid further injury.
• Follow-Up Care: If the orthotic device requires adjustments or re-evaluations, those follow-up appointments can also be billed under this CPT code.

How Does CPT Code 97750 Compare to Other Codes?

CPT Code 97750 is used exclusively for orthotic management and training. There are other codes, however, that are also part of this group. These include the following:

• CPT Code 97760: This is the code for “Orthotic and Prosthetic Management and Training,” but it is limited strictly to training on prosthetic use, that is, the use of artificial limbs rather than orthotics.
• CPT Code 97535: This is the code applied for “Self-Care/Home Management Training.” Sometimes, it overlaps with training rendered under CPT Code 97750 but generally involves much broader activities, such as teaching the patient how to manage the condition in their home.
• CPT Codes 97110, 97112, 97116: These codes are mainly used in rendering other kinds of physical therapy services, like therapeutic exercises, neuromuscular re-education, and gait training, that may complement orthotic training.

Billing Considerations for CPT Code 97750

When billing for CPT Code 97750, there are a few things to keep in mind:

• Documentation: Documentation is key. Healthcare providers must have detailed notes about the evaluation, fitting, adjustments, training, and follow-up care associated with the orthotic device. This will justify the use of CPT Code 97750 and ensure proper reimbursement.
• Modifiers: Sometimes, modifiers are needed to add additional details about the service. Modifiers can be applied if the service was given on a different day or was conducted in combination with other procedures. Make sure to use the correct modifier to express the service properly.
• Insurance coverage: The degree of insurance coverage is variable as some may only pay for parts of the costs incurred in the orthotic management and training of a patient, and it only covers patients in specific conditions or certain types of orthotic devices. Always get clarification from the patient’s insurance company about coverage details.
• CPT Code Unit: CPT 97750 can be claimed by a doctor on a unitary basis, but under certain circumstances, in case several body parts are to be treated. Such insurers can make allowance for an additional unit or fee for every treated area.

How Hello MDs Streamlines the Use of CPT Code 97750

Hello MDs streamline the usage of CPT Code 97750 by providing an all-inclusive digital platform, simplifying documentation and billing of orthotic management and training services. Hello MDs enable healthcare providers to track patient evaluations, fittings, and training sessions efficiently, ensuring accurate documentation for CPT Code 97750. This is complemented by smooth integration with insurance systems that assist providers in checking coverage and thus ease billing while minimizing administrative costs. Furthermore, Hello MDs offers templates and automated reminders to help providers prepare all necessary documents to optimize reimbursement and ensure compliance.

Conclusion

The most critical code for billing and coding of orthotic management and training is CPT Code 97750. If a provider understands what it is and when to use it, it will help providers get paid for services rendered properly. Other digital platforms, like Hello MDs, make documentation efficient to deliver the best care to patients.