CPT 97761: Prosthetic Management and Training
Medicare pays $42 and commercial payers pay $52 on average nationally for this procedure.
CPT code 97761 describes one-on-one prosthetic management and training, covering assessment, fitting, and training in the use of an external prosthesis; this service is timed and billed per 15 minutes for initial encounters and is typically provided by rehabilitation clinicians in outpatient clinics, inpatient rehab units, or skilled therapy settings where direct patient contact occurs.
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).
Customize your policy alerts
Sign up for cpt 97761 policy alerts
Get alerted when payer policies referencing 97761 are released or updated.
Monitor payer policy activity
National Reimbursement Benchmarks
Across payers, Medicare's mean rate of $41.9 sits below BUCA’s average commercial mean of $52.2, indicating commercial reimbursement is generally higher than the Medicare baseline for CPT 97761. The median values where available and Medicare’s interquartile point ($41 median) suggest Medicare remains relatively consistent around its mean, while BUCA’s mean reflects a higher commercial centroid without min/max details to show extremes.
Dispersion measured by the P75–P25 range highlights variation: Blue Cross Blue Shield’s range is $20.7, Cigna’s is $38.4, Aetna’s is $12.9, and UnitedHealth Group’s is $17.3; BUCA’s interquartile range is $22.5 and Medicare’s is $4.0. Cigna displays the widest IQR at $38.4, signaling the greatest middle-range spread, while Medicare is the tightest at $4.0, indicating the most compressed middle distribution.