4th Dec

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 .

 

Gina Tomcsik

Director of Compliance

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