CPT Code 97763: Orthotic/Prosthetic Management, Subsequent Encounter

What is orthotic/prosthetic management (subsequent visit)?

CPT Code 97763 supports orthotic management and training following an initial session. This code is used for follow-up visits where the provider works with the patient to ensure proper use, function, and adjustment of an orthotic or prosthetic device. The service may involve upper or lower extremity devices and is billed per 15-minute unit of direct contact. Each subsequent orthotic session must be medically necessary and well-documented to reflect changes in the patient's condition or progress toward their functional goals.

CPT code 97763 is applicable for the upper extremity, lower extremity, or trunk orthotic devices. Supporting documentation must justify medical necessity, detailing time spent, training provided, and any device modifications. Use with appropriate L codes, modifiers (e.g., GP), and reimbursement guidelines per CMS and insurance carrier policy.

Documentation requirements

To support billing for the 97763 CPT code, each subsequent encounter for orthotic and prosthetic management must include the following elements:

• Patient’s progress since the initial encounter, including clinical observations related to function and comfort
• Evaluation of the orthotic or prosthetic device for proper fit, tolerance, and effectiveness
• Notation of adjustments made to the device or usage instructions
• Updated functional goals, activity modifications, or therapy recommendations
• Observation of any functional improvements or setbacks during the management and training session
• Clear description of how this follow-up service is distinct from prior visits or the initial orthotic or initial prosthetic fitting and training

All documentation must align with reimbursement guidelines, reflect medical necessity, and be consistent with supporting documentation practices per American Medical Association and CMS coding guidelines. Include appropriate L codes, if applicable, and time spent during the therapy services session.

Billing guidelines

CPT code 97763 is a time-based procedural code, reported per 15-minute unit of orthotic and prosthetic management and training for a subsequent encounter. The following billing rules apply:

• It must follow an initial orthotic (97760) or initial prosthetic (97761) service.
• Use modifier GP for physical therapy or GO for occupational therapy, depending on the provider delivering the therapy services.
• Do not report this code for minor adjustments or device checks that do not involve functional training or reassessment of the patient’s condition.
• Documentation must support medical necessity, reflect the time spent, and detail the training and prosthetic or orthotic management performed during the session.
• Be aware that some insurance carriers, including Medicare, may require prior authorization or supporting documentation proving the need for continued care.

Other relevant CPT codes

• 97760 – Initial orthotic training
• 97761 – Initial prosthetic training
• 97110 – Therapeutic exercise (if conducted separately)