At Apache Health we often get questions about orthopedic billing.  We will post answers to some of these questions periodically on our blog.

 

Can an orthopedic surgeon bill for orthotic management and training?  The short answer is “No”.

It must be billed as part of physical therapy, by a physical therapist, under the care of physical therapist.  So if your orthopedic surgery practice has occupational therapy / physical therapy in the practice, then of course you can provide and bill for this service.

 

Following are the codes:

 

CPT 97760 – Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes –

Medicare allowable – $43*

 

CPT 97761 – Prosthetic training, upper and/or lower extremity(s), each 15 minutes – Medicare allowable – $37*

 

CPT 97762 – Checkout for orthotic/prosthetic use, established patient, each 15 minutes – Average Fee amount – Medicare allowable – $56*

 

*2017 Medicare fee schedule for Loc 18; please contact us for the fee schedule for your locality

Source: AMA and CMS

 

About Apache Health

Apache Health is a revenue cycle management (RCM) analytics, benchmarking, and auditing company. The founders of Apache formerly ran a large RCM company that was acquired by a private equity group in a rollup. Apache’s predictive analytics will benchmark billing performance and project exactly how much more revenue you should earn from your existing volume of patients.  Using many factors and a blend of artificial intelligence and specialty specific benchmarks, the model projects whether changing the billing process would improve collections for your particular mix of procedures and payers. Apache Health can help you evaluate whether to outsource the billing, determine which billing company to select to maximize performance, or track in-house billing performance improvement over time. For more information contact:

Sean McSweeney

Apache Health

www.apachehealth.com

888-422-5514