Update to Seating Assessment Benefits Available

Date: March 31, 2026

Attention: Providers

Effective date: April 1, 2026

Call to action: The purpose of this communication is to inform providers that beginning April 1, 2026, claims for seating assessments (procedure code 97542) can be submitted for the following procedures on the same date of service with appropriate documentation:

Physical therapy (PT) evaluations (procedure codes 97161, 97162, or 97163);
Occupational therapy (OT) evaluations (procedure codes 97165, 97166, or 97167); or
PT or OT re-evaluation (procedure codes 97164 or 97168).

How this impacts providers:
Claim information

Claims submitted for seating assessments on the same date of service as therapy evaluations or re-evaluations must be submitted with documentation of distinct start and stop times for each service.
- Seating assessment services that overlap times with therapy evaluation or re-evaluation services will be denied.
Claims for seating assessments submitted on the same date of service as therapy evaluations or re-evaluations will be manually reviewed to confirm there was no overlap with the services performed.

Next steps for Providers: Providers should share this information with their staff. Texas Medicaid managed care organizations (MCOs) like Texas Children’s Health Plan (TCHP) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO/TCHP. Administrative procedures, such as prior authorization, precertification, referrals, claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should reference a member’s specific MCO/TCHP for information on these items. For TCHP, this information can be found on the provider page available at https://www.texaschildrenshealthplan.org/providers.

The Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook will be updated to reflect this change on May 1, 2026.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.

For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts.