Nov. 4, 2026

We’re providing the reminders below to help ensure compliance with billing-related requirements specified in the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, Seating Assessment for Manual and Power Custom Wheelchairs. This information applies to Qualified Rehabilitation Professionals participating in seating assessments for manual or power custom wheelchairs.

• Certified QRPs must enroll in Texas Medicaid as performing providers under the Durable Medical Equipment provider groups.
• QRPs must be present and actively involved in the seating assessment for manual or power custom wheelchairs. They must sign the seating assessment form attesting to their participation.
• QRPs must be present at the time of delivery of the wheeled mobility system to direct the fitting and ensure the system functions correctly relative to the client.
• Services for the QRP’s participation in the seating assessment must be submitted for reimbursement by the DME provider billing for the wheeled mobility system using procedure code 97542 with modifier U1 (used for participation in the seating assessment up to four units or one hour).
• For final fitting, services must be billed using procedure code 97542 with modifier U2 (final fitting of wheeled mobility system). This will be billed in 15-minute units, with a maximum of 8 units (2 hours). The same QRP who participated in the seating assessment must be listed as the performing provider. Procedure code 97542 U2 must be billed on the same claim as the wheeled mobility system procedure code(s) for reimbursement.
• The DME provider must include the QRP specialty as the performing provider on the claim for all components of the wheeled mobility system, including the QRP’s participation in the seating assessment. 

Prior authorization must be requested at the same time and on the same prior authorization request as the QRP fitting and wheeled mobility system or major modification. Providers must include required documentation with all requests, including the signed seating assessment form and any additional Texas Medicaid-required documentation.

If you have questions, email our Medicaid Provider Network Team or call 855-212-1615 for assistance.