CPT 97760: Orthotic Management and Training, Initial Encounter
Medicare pays $48 and commercial payers pay $64 on average nationally for this procedure.
CPT code 97760 describes a billed service for orthotic management and training, where the provider performs assessment, fit adjustment, and patient training on an orthotic device for the upper extremity, lower extremity, and/or trunk; this code is reported for each 15 minutes of the initial encounter and the typical service setting is outpatient rehabilitation or clinic–based therapy focused on functional use of prescribed orthoses.
For related coverage guidance, see recent payer policy updates: Hip Arthroplasty (partial and total hip replacement), Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing), Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty).
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National Reimbursement Benchmarks
Medicare’s mean for CPT 97760 sits at $47.9, while BUCA’s average commercial mean is $63.8, indicating commercial BUCA reimbursement averages about $15.9 higher than Medicare. This gap highlights a common pattern where commercial payers pay materially more than Medicare for this service, with BUCA positioned above the Medicare mean but below some commercial peaks.
Dispersion (P75 minus P25) highlights variability by payer: Blue Cross Blue Shield’s spread is $29.3 (from $53.4 to $84.7), Cigna’s spread is $44.7 (from $44.0 to $84.7), UnitedHealth Group’s spread is $18.5 (from $40.2 to $58.7), Aetna’s spread is $27.0 (from $28.2 to $59.9), and BUCA’s spread is $31.9 (from $46.6 to $77.5). Cigna displays the widest P25–P75 dispersion and UnitedHealth Group the tightest, indicating greater variability in negotiated commercial rates for some payers compared with others.