New Evaluation Codes and Wheelchair Assessments

With the implementation of the new physical and occupational therapy evaluation codes with dates of service on and after January 1, 2017, I am receiving many questions what do I think is the proper billing when a patient is referred to either physical therapy or occupational therapy for the purpose of a wheelchair evaluation. In this article, I will answer this question from 2 perspectives. I will provide the answer for a one-time only wheelchair assessment and also provide the answer for when a full evaluation is required.

First, we need to provide the CPT code and description for wheelchair management. Per the American Medical Association, CPT Professional Edition, 2017, CPT code 97542 is defined as follows: Wheelchair management (includes assessment, fitting, training), each 15 minutes. According to CPT Changes 2006: An Insider’s View, assessment includes, but is not limited to,