How to Bill Medicare for a Wheelchair Evaluation (CPT 97542)

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


Many healthcare providers who work in rehabilitation therapy are often referred patients for the sole purpose of performing a wheelchair evaluation. Those who don’t perform these types evaluations on a regular basis may be inclined to think that it’s okay to just bill the patient for a ‘physical therapy evaluation’ (97001) or an ‘occupational therapy evaluation’ (97003) instead. But did you know that there’s a specific CPT code for this exact scenario? The CPT code which I’m referring to is known as ‘wheelchair management’ (97542).


Click here to read about when you should book for a re-evaluation.


In 2006, the ‘wheelchair management’ CPT code was modified to include assessment, fitting, and training in its description. This seemingly minor modification had significant implications for healthcare providers who occasionally perform the following tasks:


– Documenting the event or condition that caused the need for a wheelchair


– Determining the patient’s need for a wheelchair and whether they’ll need a powered or a manual wheelchair


– Determining the patient’s range of motion, balance, pain, strength levels, sensations, ability transfer, etc.


– Testing the patient’s ability to use certain styles of wheelchairs including propulsion, their ability to get in and out of the wheelchair, and use of the chair’s locking mechanism


Now that the ‘wheelchair management’ fee code covers all of these scenarios, you’re free to use it any time you’re referred a patient who’s in need of a wheelchair. Simply bill the patient, or their payor, for the appropriate number of 97542 units, based on the amount of time spent helping your patient find the wheelchair that’s right for them.


If you found this article helpful and you would like to access similar content, check out the Gawenda Seminars and find out how you can become a Gold Member today.

top icon