CPT 97760
Global XXX ActiveOrthotic mgmt&traing 1st enc
CPT 97760 Billing & Documentation Guide
CPT code 97760 (Orthotic mgmt&traing 1st enc) is classified under Physical Medicine with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.5, a non-facility practice expense RVU of 0.87, and a malpractice RVU of 0.01, a total non-facility RVU of 1.38 and facility RVU of 1.38. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $47.65, though rates vary from $41.83 to $60.62 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 97760, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 97760 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 6 units of 97760 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 97760
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.5 | 0.5 |
| Practice Expense RVU | 0.87 | 0.87 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 1.38 | 1.38 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 97760
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $51.86 | $51.86 | $49.01 - $60.62 | 29 |
| Florida | $46.51 | $46.51 | $44.98 - $47.8 | 3 |
| Georgia | $44.85 | $44.85 | $43.02 - $46.68 | 2 |
| Illinois | $45.48 | $45.48 | $43.75 - $47.25 | 4 |
| Michigan | $44.46 | $44.46 | $43.61 - $45.31 | 2 |
| North Carolina | $44.03 | $44.03 | $44.03 - $44.03 | 1 |
| New York | $50.37 | $50.37 | $44.54 - $52.94 | 5 |
| Ohio | $43.57 | $43.57 | $43.57 - $43.57 | 1 |
| Pennsylvania | $45.67 | $45.67 | $43.69 - $47.65 | 2 |
| Texas | $45.71 | $45.71 | $43.45 - $47.77 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 97760
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 97760 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0229T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0229T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0230T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0230T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 97760
What does CPT code 97760 mean? +
CPT code 97760 represents: Orthotic mgmt&traing 1st enc. It's in the Physical Medicine category with a global period of XXX.
What is the Medicare reimbursement for CPT 97760? +
The 2026 Medicare national average non-facility payment for CPT 97760 is $47.65. Rates range from $41.83 to $60.62 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 97760? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 97760? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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