March 20, 2026

We’re providing the reminders below to help ensure compliance with billing-related requirements specified within the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook §2.2.17.10. This information applies to Qualified Rehabilitation Professionals participating in seating assessments for manual or power custom wheelchairs.

QRP enrollment: Certified QRPs must enroll in Texas Medicaid as performing providers under the Durable Medical Equipment provider groups.

Seating assessment: QRPs must be present and actively involved in the seating assessment for manual or power custom wheelchairs. QRPs must sign the seating assessment form to attest to their participation.

Fitting of custom wheeled mobility system: 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.

Billing: 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). 

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: 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.

Documentation: 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.