Coding Update: Assistive Technology vs. Wheelchair Assessment

A recent CPT Assistant article, published by the American Medical Association at the request and with the support of AOTA and the American Physical Therapy Association (APTA), provides coding and billing clarification as to when 97755, assistive technology assessment, is appropriate versus 97542, the wheelchair management code.

AOTA and APTA collaborated to request coding clarification in late 2019 following a series of member questions regarding the specific scenarios when therapists and therapy assistants are treating patients in need of assistive technology that may include wheelchair management services. AOTA learned that there was significant confusion and very little CPT® coding guidance regarding the proper use of the assistive technology code over the years since the code was developed in 1996.

The CPT Assistant article clarifies that assistive technology includes “user-interface technology and/or shared control between the user and the device, such as power mobility devices (including adaptive switches and access devices), prosthetic limb control devices, functional electrical stimulation devices, and robotic exoskeletons.”

The article states that it is appropriate to use 97755 when assessing a patient’s need, and functional capacity for use of the power wheelchair’s control system, custom seating, and variable support positioning. This would include the assessment of necessary individual modifications for these components.

When should 97542 be used for a power wheelchair instead of 97755?

The article clarifies that 97542 is to be used for assessment, fitting, and training, which includes positioning, pressure relief, getting in and out of the wheelchair safely, and managing propulsion. If the reason for the assessment falls only in these areas, and there is no user-interface component of the assessment, 97542 is the appropriate code regardless of whether the wheelchair is power or manual.

Code 97755 is not to be used for training in the use of assistive technology. Such training should be billed under 97535 (self care/home management) or 97537 (community/work reintegration), as appropriate.

For both 97755 and 97542, time spent writing the assessment report is not separately reportable.

For additional guidance regarding appropriately coding and billing occupational therapy services, email regulatory@aota.org.

CPT Assistant article used with permission of the American Medical Association. American Medical Association, Coding Clarification: Codes 97542 and 97755, CPT Assistant Newsletter, March 2021, p.4. ©Copyright American Medical Association 2021. All rights reserved.