How the New Evaluation CPT Codes Relate to Wheelchair Assessments

Please note that this article contains information that is only relevant to American clinics.


If you’ve seen any patients for either a PT or an OT assessment since January 1, 2017, then you’re well aware that you’re required to use a new set of evaluation codes. There are six of them in total: three for PT evaluations, and three for OT evaluations. And each of the three evaluations denotes a different complexity level—we’ve spoken at length about this is previous blog posts. But what we have yet to cover is how these new evaluation codes relate to wheelchair assessments.


Click here to read about the role of ‘Complexity’ levels in the new PT evaluation codes.


As you know, there’s a special CPT code specifically for wheelchair assessments—CPT 97542. This particular CPT code speaks to fitting, and training patients on proper wheelchair use. But assessments are not synonymous with evaluations. Oftentimes, an evaluation needs to take place before you can determine if wheelchair is truly necessary.


Do you know how to bill Medicare for a wheelchair evaluation? Click here to find out.


“For many patient situations, a full patient evaluation is needed to develop the appropriate treatment plan in addition to wheelchair fitting and training,” said Rick Gawenda from Gawenda Seminars and Consulting. He also explained that state practice acts require a therapist to perform an evaluation before they attempt to develop a plan of care. Thus, the information gathered from the evaluation can then be used to determine if the patient truly requires a wheelchair. And if so, you can proceed with the wheelchair assessment.


We hope that you found this article helpful. Be sure to check out the Gawenda Seminars website and Consulting and learn more about the benefits of becoming a Gold Member.