CPT Code 97542: Wheelchair Management/Propulsion Training

CMS 2026 Update — CPT 97542

CPT 97542 (Wheelchair management training) remains supported under CY2026 guidance when training is skilled and tied to functional goals. Document device training, patient safety, and measurable improvements.

What is CPT 97542?

CPT 97542 represents Wheelchair Management — a service involving training patients in the effective use and management of wheelchairs, including safety and mobility techniques.

Typical uses: This code is used in rehabilitation settings to enhance patient independence and mobility.

In short: CPT 97542 = Training in wheelchair use and management.

When to Use CPT 97542 (and When Not To)

Use 97542 for training patients in wheelchair skills, including maneuvering, safety, and maintenance.

• Report when providing individualized wheelchair training sessions.
• Include documentation of specific skills taught and patient progress.

Do not use for general physical therapy sessions unrelated to wheelchair management.

Clinical Examples

• Training a patient to navigate curbs and ramps → 97542
• General physical therapy for lower limb strength → 97110

97542 vs 97110 (Quick Comparison)

2025 Reimbursement Rates (Representative)

Documentation Guidelines (CMS & MIPS 2025 Compliant)

Thorough documentation demonstrates medical necessity, skilled care, and functional intent. Include:

1. Functional goal (e.g., “Patient will independently navigate wheelchair through home environment”).
2. Activity description — explicit tasks practiced, environment, and level of assistance.
3. Clinical rationale — why this activity addresses the patient’s deficit.
4. Time documentation — minutes per activity and total minutes (apply the 8-minute rule for units).
5. Patient response — tolerance, cues required, measurable progress.

Sample SOAP Note (De-identified)

S: Patient reports difficulty maneuvering wheelchair over uneven surfaces.
O: Practiced navigating ramps and curbs with moderate assistance; required verbal cues for safety.
A: Patient demonstrates improved control but continues to need assistance with inclines.
P: Continue wheelchair training focusing on independent navigation of varied terrains.
  

Modifiers & Coding Tips

Claim tip: Ensure documentation supports the use of modifiers to avoid denials.

Common Denials & How to Prevent Them

1. Insufficient documentation — Fix: Ensure all training activities and patient responses are thoroughly documented.
2. Incorrect modifier usage — Fix: Apply modifiers appropriately and ensure they are justified in the documentation.
3. Lack of medical necessity — Fix: Clearly document the clinical rationale for wheelchair training.

Audit trigger: Repeated billing of 97542 without clear documentation of distinct services.

Region & Local Payer Notes

In North Carolina, ensure compliance with Noridian Healthcare guidelines for Medicare claims. Local variations may apply, so verify with regional payers.

FAQs

What is included in wheelchair training?

Wheelchair training includes mobility skills, transfers, pressure relief, and safety instruction tailored to the patient’s needs.

How to document device settings?

Record wheelchair type, setup adjustments, and fitting parameters used during training.

Can caregivers be trained for wheelchair care?

Yes — document caregiver instruction, demonstration, and competency observed.

Is 97542 time-based?

Yes — record minutes spent on wheelchair training and any concurrent interventions separately.

What leads to denials?

Denials result from vague training descriptions, missing device details, or lack of measurable outcomes.

How to coordinate with DME suppliers?

Communicate device needs, fitting results, and training outcomes with DME suppliers to ensure proper equipment delivery.