Billing code 97542: Wheelchair trainingMedicare rate & RVUs in Oklahoma
A therapist assesses wheelchair needs, fits or adjusts the chair, and trains the patient to use it safely and effectively.
Medicare pays $29.42 for 97542 in the office in Oklahoma (Oklahoma). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 97542 covers
Physical and occupational therapists use this service to assess a patient’s wheelchair needs, fit or adjust the chair, and provide skilled training in its use. Training may address safe operation, propulsion, and maneuvering in the patient’s mobility environment. It is commonly furnished in outpatient rehabilitation clinics and hospital settings when a patient needs instruction or an individualized wheelchair setup to support mobility.
Report the service in 15-minute units for skilled wheelchair assessment, fitting, or use training, and document the intervention, time, and patient’s response or progress. Distinguish wheelchair-specific instruction from broader self-care training or therapeutic activities. This is a therapy service, so a professional-component modifier does not apply. Under the therapy multiple procedure payment reduction, CMS reduces the practice-expense portion for the second and later therapy units furnished on the same day.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
97542 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | $29.42 | Unavailable |
How the 97542 rate is calculated
Each of 97542’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 97542
RVUs × geographic indexes × conversion factor
Work0.48
0.48 RVUs× 1.000 GPCI
Practice expense0.44
0.44 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.9300
Conversion factor
$33.4009
Medicare rate
$31.06
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97542
The CMS indicators that decide how 97542 is paid alongside other services.
CMS payment indicators · 97542
Wheelchair training
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 5 | Therapy reduction: practice expense of the second and later units is reduced. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
97542 without CQ · national office
$31.06
Wheelchair training
97542-CQ · Allowed amount unchanged
$31.06
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
97542 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 97535Self-care training
- Choose 97542 for wheelchair assessment, fitting, and use instruction. Choose 97535 when the skilled intervention trains self-care or daily living tasks.
- 97530Therapeutic activities
- 97530 covers dynamic therapeutic activities; 97542 is specific to wheelchair assessment, fitting, or use training.
- 97537Reintegration training
- 97537 focuses on community or work reintegration activities. Use 97542 for wheelchair-specific assessment, fitting, and instruction.
97542 billing questions
When should I report wheelchair training instead of self-care training?
Report this code for skilled assessment, fitting, or instruction focused on wheelchair use. Use self-care training when the intervention focuses on daily living tasks rather than wheelchair-specific skills.
Is this code reported in timed units?
Yes. The service is reported in 15-minute units. Document the skilled wheelchair intervention and the time supporting the units billed.
Can wheelchair training and therapeutic activities be reported on the same date?
They may be reported together when each represents a distinct skilled intervention. Document the wheelchair-specific training separately from the therapeutic activities.
Does modifier 26 apply?
No. This is a therapy service, and the professional-component modifier does not apply.
How does the therapy multiple procedure payment reduction affect this code?
For the second and later therapy units furnished on the same day, CMS reduces the practice-expense portion of payment.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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