All You Want to Know About custom CPT codes for Orthotics.

Orthotics are integral to podiatry practice, providing potential treatments for various disorders. Orthotics have fixed charges, which might be a financial strain if they are not paid on time. The staff should be familiar with the coverage standards established by the major insurance companies with whom the practice frequently works to receive payment for the service. It saves much time determining whether the patient’s insurance supports orthotics. It is critical to have sound knowledge about eligibility conditions and coverage limits. Moreover, it is also important to know billing rules and CPT codes for orthotics. Many offices have difficulty receiving payment for custom orthotics due to incorrect billing of the CPT code for orthotics.

Most professionals in the field of orthotics are concerned about the billing of orthoses. Modern medical facilities must seek compensation from the patient’s insurance provider. It involves submitting a formal claim for payment to the appropriate person. Due to this, it is essential to understand how to bill for custom orthotics in every way, including using the CPT code for orthotics.

This blog sheds light on the CPT code for orthotics. So, let’s learn everything about custom orthotics CPT codes.

CPT Code for Orthotics

Depending on the insurer and policy, custom orthotics may be covered in various ways. Before prescribing custom orthotics to a patient, verifying coverage with their insurance provider is important. If you have patients without network insurance, you should request cash payments and submit a letter justifying the medical necessity. Other alternatives include flexible spending arrangements and accounts for tax-free healthcare bills. Inform the patient, if they are paying cash for their orthotic, of the services included with their purchase (fitting, follow-up visits, training, adjusting, etc.).

The CPT codes 97760 and 97762 define the evaluation, care/fitting, training, and management of orthotic services. Let’s explore these CPT codes for orthotics in detail.

Orthotics CPT Code 97760

Custom orthotics CPT code 97760 is for examination, casting, education and training.

1. This method can be considered acceptable and necessary if there is a need for orthotic education and evidence that it is being utilized for its intended purpose.
2. Typically, completion of orthotic training requires three sessions. If the orthotic must be altered due to tissue healing, edema alteration, or skin integrity loss, the patient may be required to return for additional sessions.
3. It is required to document each orthotic treatment for the upper and lower limbs in the patient’s medical record.
4. The patient can receive instructions on how to utilize the recommended medical equipment.
5. Suppose there is a purpose to learning how to use a prosthesis, and there is proof that it is being utilized beneficially. In that case, this therapy and training may be judged appropriate and necessary.
6. The medical record should indicate the various goals pursued and the services provided when prosthetic training is performed for the upper and lower extremities.

Orthotics CPT Code 97762

Custom orthotics CPT code 97762 is for orthotic check-in, fitting and dispensing.

1. When a recently issued device needs to be altered or reissued, or when a recently issued device requires a second look, these evaluations are acceptable and required.
2. When a patient claims that a device caused them any issue like pain, falls, or skin breakdown, it may be appropriate and required to conduct the assessment.
3. These assessments may be necessary to determine how the patient reacts to wearing the device, whether the patient requires socks, cushioning, or under wraps and how well the patient can tolerate dynamic forces being applied.

To draft a perfect claim, one must have a high level of precision and a thorough awareness of billing standards and procedures. A “perfect” claim is comprehensive and accurate, which the insurance company will not deny.

There are many additional aspects to consider. Orthotics for the right and left foot must be coded and billed on different lines of the claim form using the correct code and the “-RT” or “-LT” modifiers.

For instance, L3000RT is used for billing for the right foot orthotics. Similarly, L3000LT is used for billing for orthotics for the left foot.

See Also: Common ICD 10 Codes for Gastroenterology

Conclusion

The CPT codes for orthotics are 97760 and 97762. These codes represent every aspect of orthotic services, including the evaluation, training, management, and fitting of orthotics. For profitability and revenue of the practice, it is crucial to use the correct CPT code for orthotics with the appropriate modifier. Failure to do so results in a claim denial, negatively impacting the revenue cycle.

Coding errors can result in lost revenue, and if they occur frequently enough, they can significantly impact a practice’s capacity to generate income. Service providers know this reality and try to find and retain trained employees to manage billing and coding for custom orthotics to minimize financial losses. Regarding invoicing and coding, many orthotics clinics seek assistance from third-party professionals.

If important custom orthotics billing tasks are outsourced to specialized billing professionals, it can do wonders for reducing operational expenses and producing superior results. The most significant advantage of using a billing organization for custom orthotics is that providers have instantaneous access to a large pool of trained billing experts at a substantially cheaper cost than they would pay for in-house labor.

Precision Hub provides expert and specialized assistance for custom orthotics billing and coding, which can be advantageous across the revenue cycle. It is particularly effective for raising collection rates, which can result in substantial cost savings. Additionally, denial rates are reportedly substantially lower, which has led to a significant increase in the number of passed initiatives. It is because of fewer code errors and other issues, which is a natural advantage of having experienced and focused team members. So, call us now to achieve the maximum revenue for your practice.