How to Bill for Orthotics Efficiently

In contemporary society, orthotics and DME (Durable Medical Equipment) have become indispensable components of the daily life for individuals. The significance of orthotic equipment, such as specialized shoes or heel inserts, extends beyond mere utility, often contributing to substantial improvements in the quality of life for countless people nationwide. Yet, for healthcare providers, navigating the intricate realm of orthotics billing poses considerable challenges. Managing the ever-evolving code updates, documentation prerequisites, and optimal practices can prove daunting in this complex landscape.

Understanding the Key Requirements for Orthotics Billing

Orthotics billing primarily revolves around three key CPT codes, which are…

  • Orthotics Initial Encounter

CPT Code 97760 for Orthotics Initial Encounter – Here orthotic(s) management and training, including assessment and fitting when not otherwise reported, for upper extremity(ies), lower extremity(ies), and/or trunk, during the initial orthotic(s) encounter, is billed in increments of 15 minutes.

  • Prosthetics Training

CPT Code 97761 – Prosthetics Training – Here prosthetic(s) training for upper and/or lower extremity(ies) during the initial prosthetic(s) encounter, is billed in increments of 15 minutes.

  • Subsequent Orthotics/Prosthetics Encounter

CPT Code 97763 – Subsequent Orthotics/Prosthetics Encounter – Here management and/or training for orthotics/prosthetics involving upper extremity(ies), lower extremity(ies), and/or trunk during subsequent encounters, is billed in increments of 15 minutes.

It is evident from the above that a complete and deep understanding of billing and coding particulars is extremely essential here.

What are the Documentation Requirements for Orthotics Billing and Best Practices?

Detailed documentation is essential for each encounter. In fact, accurate documentation not only ensures accuracy but also a seamless orthotics billing transaction and lesser denials. In fact, here are a few documentation guidelines that you need to consider while you bill for orthotics.

  • Description of fabricated, adjusted, or trained orthotic/prosthetic
  • Reason for fabrication, adjustment, or training
  • Activities or exercises performed with the orthotic
  • Description of the client’s condition and response to treatment
  • Ensure medical records substantiate the necessity of the orthotic/prosthetic, including diagnosis, clinical course, prognosis, and functional limitations.

It is also important to know that Orthotics Management can be billed on the same day as the OT evaluation if documentation supports a separate and distinct encounter. Further, billing for orthotics management is allowable for both custom-made and prefabricated orthotics.

Use of Orthotics L Codes:

Orthotics not fabricated on-site typically has appropriate L codes for billing.

Providers can choose to either send patients to suppliers who bill Medicare directly, or keep a supply in the clinic and bill Medicare upon dispensing.

Partnering with an Orthotics Billing Expert

Navigating orthotics billing requires expertise and precision to ensure compliance and maximize reimbursements. At Sunknowledge Services Inc., we specialize in orthopedics/DME billing and coding, offering comprehensive solutions to streamline your revenue cycle management. Catering to all your billing needs with our tailored solutions, we are also the top RCM expert with the highest productivity metrics. For the last two decades, we are the only RCM expert who has further mastered the art of working with both payers and providers, guaranteeing the best outcome from your billing activities.

So, are you ready to optimize your O&P billing? Call us right now so we can schedule a consultation with our experts today. Let us handle your billing and other Practice Management complexities while you focus on providing exceptional patient-care.