Wheelchair Fitting and Evaluation Writing for Adults: Tips for OTs

Wheelchair Fitting and Evaluation Writing for Adults: Tips for OTs


If you’ve worked in skilled nursing or similar settings long enough, you may have noticed that standard, manual wheelchairs provided by each facility do not universally meet each resident’s or patient’s functional needs. Occupational therapists play a vital role in their patients’ daily lives, advocating to improve their mobility and body positioning so they can safely participate in necessary self-care tasks with greater independence. This means embarking on the challenging, but rewarding, journey of obtaining a customized wheelchair.


My patient needs a customized wheelchair: Where do I start?

Concerns arise about a patient on your caseload who could greatly benefit from a custom-fit wheelchair, and it’s your very first one. Where do you begin? Get your wheelchair referral and fitting crowd put together:


  • Establish a healthy relationship with your in-house primary physician: This is going to take effort on your part by reaching out to your facility doctor. Consult with the nurses and administration to familiarize yourself with the doctor’s schedule. All you need is a couple of minutes to establish communication for referrals and signing wheelchair paperwork. Without the doctor’s signature, you can’t start your assessment or obtain medical insurance coverage. For more information about what order to obtain your referral and ethical considerations, look here
  • Connect with a reputable equipment specialist: Find an equipment specialist who knows their wheelchairs and who can work out a flexible schedule. This means either researching equipment companies in your area or creating working relationships with equipment providers who come to your facilities for demonstrations. Consult with fellow therapists about reputable providers in your area. A high-quality equipment specialist will show you the ropes by teaching you the wheelchair assessment language, attending the fittings with you, providing demonstration chairs for patients to practice in, and keeping you in the loop on medical insurance bids and annual coverage updates.
  • Consult with your rehab team leader (RTL): As you adjust to writing wheelchair evaluations and working the wheelchair fitting into patient treatment sessions, consult with your RTL or manager and make sure you are getting the support you require. While wheelchair fitting, positioning, and training are billable OT treatments, wheelchair assessment writing is conducted under non-billable time that cuts into productivity percentages. 
  • Contact a wheelchair fitting and evaluation mentor: If you are brand new to the world of wheelchair assessments and fittings, it never hurts to seek out extra help or mentorship from fellow OTs who’ve been through the process. Take a lunch or coffee break, or at minimum send an email or two, and soak in as much knowledge from another occupational therapist. 



How do I obtain a wheelchair referral for my patient?

Similarly to obtaining any occupational therapy services for your patient, you need to fill out a treatment order either in a written or digital format to be signed by the in-house primary physician. The treatment order should only provide the doctor with a small glimpse into why you are seeking a fitting and evaluation for a customized wheelchair. Examples may include:


  • OT to fit and assess pt for customized tilt-in-space wheelchair to promote upright posture for safe, independent self-feeding.
  • OT to fit and assess pt for customized powered chair to increase independence in self-propulsion for access to bathroom for toileting tasks. 


The customized wheelchair could be the bridge between the patient and multiple functional tasks, facilitating independence in a vast majority of self-care and mobility activities. However, the treatment order only needs to pique the doctor’s interest with a primary, functional goal and justify the referral. 


NOTE: For Medicare patients, patients must receive a face-to-face visit from a primary physician to verify and establish a need for any powered wheelchair or scooter referral within a home or residential facility. Medicare will not fund a powered wheelchair solely for community access. 


What should the fitting session look like?

The fitting session is conducted during billable treatment minutes with the OT, the equipment provider, and the patient at the same time because this prevents any confusion about wheelchair measurements and functional impediments. While the equipment provider is responsible for taking and recording specific wheelchair and positioning measurements, it’s the OT’s responsibility to assess and factor in all current functional and self-care capacities:


  • Sitting/standing balance and duration
  • Asymmetrical posture, hemiparesis/hemiplegia, or other paralysis
  • Assist levels in toileting, hygiene, self-feeding, dressing, bathing, bed mobility, functional transfers, etc.
  • Cognitive capacity and safety awareness (ESSENTIAL information for operating a powered wheelchair)
  • Visual and perceptual deficits (also essential for operating any wheelchair safely)
  • Upper extremity strength and range of motion for wheelchair propulsion
  • History of compromised skin integrity, wounds, bed sores
  • History of ground-level of falls


Can my patient practice with a demo wheelchair?

Yes! In fact, having the patient practice in a demo chair is highly encouraged since they’ll be expected to use it regularly for at least 5-10 years. Practicing in a demo chair is typical for patients who are going to be fitted for a powered chair so the patient and the facility know they can operate the new system safely. Certain chairs may be difficult to demonstrate fully if the model is highly customized to the patient’s body positioning and size. However, your equipment specialist may have ways to work around it piece by piece (i.e., wheelchair cushions, lateral supports, contoured back supports, head supports, etc.). 


How to justify insurance coverage for a customized wheelchair:

This part of wheelchair evaluation is where you need to think like a lawyer. While writing or filling out the wheelchair evaluation, you need to thoroughly justify why your patient needs a specific customized wheelchair covered by insurance, whether manual or powered by considering the following:


  • Why the patient needs a wheelchair versus a walker
  • Why the patient needs a customized wheelchair versus a standard facility wheelchair with a new cushion
  • Why the patient needs a powered wheelchair versus a manual wheelchair


Overall, you need to justify why that particular wheelchair is essential to your patient’s overall functionality, well-being, and quality of life and what consequences will occur without it: postural instability, non-healing wounds, increased falls, poor respiratory capacity, aspiration, etc.


Are there evaluation forms available for Medicare-covered wheelchairs?

When it comes to evaluation forms, OTs are not expected to start from scratch. Today, there are forms available for manual and powered wheelchairs when seeking coverage under Medicare, Medicaid, and some private insurance providers. Your equipment specialist may have recommendations on the most up-to-date forms per insurance provider and device. Depending on your patient’s unique needs, utilize a form that allows for additional comments or appendices as needed. 


What happens if insurance denies coverage for a wheelchair?

Unfortunately, denied medical coverage does happen, especially for OTs who are getting acquainted with filling out wheelchair evaluation forms correctly. If you do get denied, talk to your equipment specialist regarding revisions or whether you need to go a different route to meet your patient’s mobility needs. Do your best to prevent denied coverage by providing as much detail as possible the first time, proof-reading your work, and double-checking all signatures and dates. 

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