Therapists will be seeing some changes in CPT codes. These changes are outlined below.
ORTHOTICS AND PROSTHETICS: The CPT Editorial Panel revised the set of codes physical and occupational therapists use to report orthotic and prosthetic interventions by differentiating between initial and subsequent encounters:
- 97760: Orthotic(s) management and training including assessment and fitting when not otherwise reported, upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes
- Change: the term “initial encounter” was added to the code descriptors for CPT code 97760 for orthotic
- 97761: Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes)
- Change: the term “initial encounter” was added to the code descriptors for CPT code 97761for prosthetic
- 97763: Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes
- Change: new coded added to describe all subsequent encounters for orthotics and/or prosthetics management and training services
- 97762: was deleted
COGNTIVE SKILLS DEVELOPMENT: The CPT Editorial Panel also created CPT code 97127 to replace/delete CPT code 97532.
- CMS will recognize HCPCS code G0515, instead of CPT code 97127
- CPT code G0515 will be added to the therapy code list.
- CPT code G0515: Development of cognitive skills to improve attention, memory, problem solving includes compensatory training, direct one-on-one patient contact, each 15 minutes
- CPT code 97127 will be assigned a payment status indicator of “I” to indicate that it is “invalid” for Medicare purposes and that another code is used for reporting and payment for these services.
- Facilities will need to check with other payers (Non-Medicare Payers) to see if they will be using 97127 or G0515.
- Therapists will use 97127 for Non-Medicare beneficiaries when cognitive skills development is used.
- CPT code 97127 is a service based code.
To read the full article from CMS regarding these changes, please click Here .
Director of Compliance