CPT code 97763: Orthotic/prosthetic care, subsequent encounter2026 Medicare rate & RVUs in Missouri
Report 97763 for timed follow-up management or training involving an orthosis or prosthesis after the initial encounter.
Medicare pays $45.44–$48.48 for 97763 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 97763 covers
A therapist or other qualified practitioner uses this service at a follow-up visit to assess and manage an orthosis or prosthesis, address fit or function, make appropriate adjustments, and train the patient in use. Examples include follow-up instruction in using a brace or prosthetic limb and reassessment of how the device is working during daily activities. The service is commonly furnished in outpatient rehabilitation or a practitioner’s office.
Choose 97763 for a subsequent encounter rather than the initial orthotic or prosthetic service; report it in 15-minute units. Document the device, the skilled management or training performed, the patient’s response, and the timed service. This therapy service is not divided into professional and technical components, so modifier 26 is not appropriate. CMS reduces practice expense for the second and later therapy units furnished on the same day.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 97763 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$45.44 to $48.48
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $48.04 | Unavailable |
| Metropolitan St. Louis, MO | $48.48 | Unavailable |
| Rest of Missouri | $45.44 | Unavailable |
How the 97763 rate is calculated
Each of 97763’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 97763
RVUs × geographic indexes × conversion factor
Work0.48
0.48 RVUs× 1.000 GPCI
Practice expense1.01
1.01 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
1.5000
Conversion factor
$33.4009
Medicare rate
$50.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97763
The CMS indicators that decide how 97763 is paid alongside other services.
CMS payment indicators · 97763
Orthotic/prosthetic care, subsequent encounter
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 5 | Therapy reduction: practice expense of the second and later units is reduced. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
97763 without CQ · national office
$50.10
Orthotic/prosthetic care, subsequent encounter
97763-CQ · Allowed amount unchanged
$50.10
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
97763 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 97760Orthotic trainingInitial encounter
- Use 97760 for the initial orthotic management and training encounter. Use 97763 for subsequent orthotic or prosthetic management and training.
- 97761Prosthetic trainingInitial encounter
- 97761 covers initial prosthetic training; 97763 covers subsequent management or training involving an orthosis or prosthesis.
- 97750Performance testTimed testing with written report
- 97750 reports a physical performance test. Choose 97763 when the service is follow-up management or training for an orthosis or prosthesis.
- 97755Assistive technologyFace-to-face assessment
- 97755 is an assistive technology assessment. Use 97763 for subsequent management or training involving an orthosis or prosthesis.
97763 billing questions
How does 97763 differ from 97760 and 97761?
97763 is for subsequent orthotic or prosthetic management and training. 97760 is the initial orthotic management service, while 97761 is initial prosthetic training.
How many units should be reported?
The code is reported in 15-minute units. Document the timed service and the management or training performed at the visit.
Can modifier 26 be appended?
No. This therapy service is not split into professional and technical components, so modifier 26 is not appropriate.
What happens to payment for multiple therapy units on the same day?
CMS reduces the practice expense for the second and each later therapy unit furnished that day.
What documentation supports a subsequent encounter?
Record the orthosis or prosthesis addressed, the follow-up assessment or training provided, the patient's response, and the timed service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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