CPT Code 97760: Orthotic(s) Management and Training, Initial Encounter

What is orthotic management and training (initial)?

The Current Procedural Terminology (CPT) code 97760 by the American Medical Association refers to the initial encounter where a provider delivers orthotic management and training services. This includes the assessment, fitting, and instruction in the proper use of an orthotic device for either the upper or lower extremity.

Often used in physical therapy, skilled nursing facilities, and outpatient occupational therapy settings, this service supports medical necessity by addressing the patient's condition through a treatment plan tailored to custom orthotics of L-code devices.

To ensure reimbursement under the Medicare physician fee schedule, documentation must reflect direct contact and therapy services provided during the initial orthotic's encounter.

CPT code 97760 documentation requirements

To accurately report CPT code 97760, documentation must support that the initial encounter involved the orthotic management and training, not the fabrication or supply of the orthotic device. The following must be included in the physical therapy notes or occupational therapy documentation:

• Type of orthotic device and body region (e.g., upper extremity, lower extremity)
• Medical necessity (e.g., drop foot, cerebral palsy, post-surgical stabilization)
• Patient instruction on the proper use, care, and safety of the orthosis
• Functional training in gait training, transfers, or daily task performance
• Initial assessment date, fitting, and care goals tied to the orthotic's role in the treatment plan

Providers must ensure direct contact with the established patient, and the encounter should focus on training and clinical integration of the orthotic management. Supporting documentation improves clarity for insurance carriers, helps avoid claim denials, and ensures compliance with Medicare and other reimbursement guidelines.

Billing guidelines

CPT code 97760 is used for the initial encounter involving orthotic management and training, and it should only be reported once per orthotic device and body region (such as the upper extremity or lower extremity). The service must include direct contact between the provider and the patient and is typically billed by a physical therapist or occupational therapist.

For subsequent encounters, such as ongoing orthotic training or gait training, use appropriate re-evaluation or therapeutic activity codes; 97760 does not apply beyond the first session. Additionally, orthotic fabrication and supplies should be billed separately using the relevant L codes, as these are not included in 97760.

Always append the correct modifier depending on the type of therapy provided:

• Use GP for physical therapy services
• Use GO for occupational therapy services

Keep in mind that Medicare Part B, other insurance carriers, and medicare administrative contractors (MACs) may have specific reimbursement guidelines, including limits on covered sessions and prior authorization requirements. Confirm these details in advance to prevent claim denials.

Lastly, make sure the documentation supports medical necessity, the patient’s condition, the treatment plan, and the total duration of services. Accurate reporting aligned with current procedural terminology will help maintain compliance and support appropriate reimbursement.

Other relevant CPT codes

• 97761 – Prosthetic training
• 97763 – Orthotic/prosthetic management, subsequent encounters
• 97110 – Therapeutic exercise