2025 HCPCS code G9156
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Evaluation - Wheelchair Evaluation Provider Assessment for Wheelchair Feed
Evaluation for wheelchair requiring a face-to-face visit with a physician.
Modifiers may apply depending on the circumstances of service. Consult current coding guidelines and payer-specific instructions.
The wheelchair must be medically necessary to improve the patient's mobility and ability to perform daily activities. Documentation must support the medical necessity, linking the patient's diagnosis, functional limitations, and the benefits of the wheelchair in restoring independence.
The clinical responsibility lies with the physician or qualified healthcare professional who performs the face-to-face evaluation, assesses the patient's mobility needs, and determines the medical necessity of a wheelchair.They are also responsible for providing the seven-element prescription.
In simple words: This code is used when a doctor (or a nurse practitioner or physician assistant) sees a patient in person to find out if they need a wheelchair.Medicare requires this visit. After the visit, the doctor sends information to the supplier who will provide the wheelchair.
This HCPCS code (G9156) represents a face-to-face evaluation by a physician (or qualified healthcare professional, such as a physician assistant or nurse practitioner) to assess a patient's need for a wheelchair.Medicare mandates this in-person visit to determine wheelchair necessity for mobility.Following the evaluation, the provider must submit a seven-element prescription to the supplier within 45 days.These elements include the patient's name, item description, assessment completion date, diagnosis, anticipated duration of need, provider signature, and face-to-face visit date. The wheelchair must address the patient's mobility needs for daily activities. Medicare covers the evaluation if documented as medically necessary.
Example 1: An elderly patient with decreased mobility due to osteoarthritis presents to their primary care physician for evaluation of their need for a wheelchair. The physician performs a face-to-face assessment, documents the medical necessity, and submits a seven-element prescription for a wheelchair., A patient recovering from a stroke experiences significant lower extremity weakness.A physical therapist, under physician referral, performs a face-to-face evaluation to determine the need for a wheelchair for improved mobility and daily living. The referring physician approves the findings and supports the prescription., A patient with multiple sclerosis exhibits progressive mobility impairment. A neurologist conducts a comprehensive evaluation, determining the necessity for a wheelchair to maintain independence.The neurologist provides the required seven-element prescription.
* Detailed medical history of the patient's mobility issues.* Documentation of the face-to-face encounter between the patient and the provider.* Thorough assessment of the patient's functional abilities and limitations.* Justification for medical necessity of a wheelchair, specifying how it improves daily living activities.* Seven-element prescription submitted to the supplier within 45 days of the evaluation.* Copies of relevant diagnostic reports, such as imaging studies or physical therapy notes.
** This code is particularly relevant in the context of Medicare's efforts to reduce improper payments for power mobility devices. Payers may have specific requirements for documentation and medical necessity.
- Revenue Code: Revenue codes will vary depending on the payer and the specific context of service. Consult payer-specific guidelines and revenue code crosswalks.
- RVU: RVUs are not provided in the source data.Consult current Medicare Physician Fee Schedule or other relevant payer fee schedules for RVU values.
- Global Days : Not applicable. This is an evaluation code, not a procedure with a global period.
- Payment Status: Active (Carrier judgment - C)
- Modifier TC rule: Not applicable.This code represents an evaluation, not a procedure with technical components.
- Fee Schedule : Historical fee schedule information is not included in provided sources. Refer to publicly available CMS data or other relevant payer fee schedules for historical data.
- Specialties:Physical Medicine and Rehabilitation, Neurology, Geriatrics, Primary Care
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Skilled Nursing Facility, Other Place of Service (depending on the patient's location)