I am often asked how to bill for a patient that is referred to outpatient physical therapy or occupational therapy for the sole purpose of a wheelchair evaluation. I am asked do I just bill the appropriate evaluation code (97001 or 97003)? Do I bill the appropriate evaluation code as well as CPT code 97542 – Wheelchair management (eg, assessment, fitting, training), each 15 minutes? Or do I bill the entire wheelchair evaluation under CPT code 97542? In this article, I will answer how to bill for a patient referred to physical or occupational therapy for the sole purpose of evaluating and assessing for the need of a wheelchair.
In 2006, CPT code 97542 was modified to include the words assessment and fitting in its description. According to CPT Changes 2006: An Insider’s View, “the words assessment and fitting were included in the code descriptor to more completely describe the components of this service”.
Assessment includes, but is not limited to:
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.