MedicaidBilling CodesMedium impact
Billing for Assessment Required by DME Form 3701H, Seating/Mobility Evaluation
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy·Provider Notice
Effective date
Nov 17, 2014
We identified it
Jun 20, 2026
Summary
Physical and occupational therapists can now bill CPT codes 97001 (PT Evaluation) or 97003 (OT Evaluation) for assessments required for power mobility devices and custom manual wheelchairs using DME Form 3701H. These evaluation codes do not require prior approval when billed for seating/mobility assessments.
Action Required
Immediately: Update billing system to allow CPT 97001 and 97003 for seating/mobility evaluations without prior authorization requirements. Train therapists to use these codes instead of 97542 for DME Form 3701H assessments. Verify patient eligibility to confirm they are enrolled in fee-for-service, ACE, or CCE plans (not MCO/MCCN) before using these billing guidelines.