When any custom wheelchair or seating system is requested, the CSHCN Services Program requires an assessment utilizing the CSHCN Services Program Wheelchair Seating Evaluation Form to be submitted by a PT or OT not employed by a DME provider. Assessments are also required when an existing seating system is being modified. CSHCN Services Program-approved custom DME providers are required to submit these forms with their requests for prior authorization.
Requests for customized manual wheelchairs must include a complete description of the specific base, any attached seating system components, and any attached accessories not included in the base price. Requests must also include the MSRPs for the individual components, including justification for components that would be considered part of the wheelchair. The CSHCN Services Program requires that the manufacturers’ price sheets be submitted along with price quotes at the time of submission for authorization. If a price change occurs after the authorization has been granted, the provider must submit new price sheets with the claim to document the price changes so that the price discrepancy between the authorization and the claim can be manually reviewed.
