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Texas F00098 Wheelchair Seating Assessment (CCP/HHS)

Texas Medicaid requires this eight-page seating assessment for the purchase of, or major modifications to, a wheelchair, scooter or stroller under CCP or Home Health Services. A physician or physical or occupational therapist documents tone, postural control, history, function, home and school environment and the equipment requested, with a Qualified Rehabilitation Professional present. It accompanies the prior authorization request to TMHP.

Who completes it

A physician, PT or OT conducts the assessment and signs, and a Qualified Rehabilitation Professional (QRP) participates and co-signs with an NPI. The measuring worksheet is signed by the measurer and the QRP.

Submitting and payment

How to submit it
Submit with the prior authorization request through TMHP's PA on the Portal, which TMHP says is faster, or by fax; faxed requests can take up to 24 hours to be scanned and entered.

Good to know

  • Complete Sections I to VII for manual wheeled mobility and Sections I to IX for power; the Home Health/CCP Measuring Worksheet is required for all requests.
  • Power requests must explain why a manual chair will not work, how the chair will be driven, whether drive controls were tested and whether access may change within five years.
  • Attach manufacturer information and an itemized list of retail prices for every addition not included in the base model price.
  • Any incomplete portion may get the prior authorization pended for more information, and the submitter must check We Agree on the certification statement. Revised 07/28/2021.

Get the official form

Download the current version from the source each time; forms change without notice.

Wheelchair/Scooter/Stroller Seating Assessment Form (CCP/Home Health Services)

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can complete the Texas F00098 seating assessment?

A physician or a physical or occupational therapist conducts and signs the seating assessment. A Qualified Rehabilitation Professional must be present and participate in the assessment for all wheeled mobility systems and major modifications, and signs with an NPI alongside the physician or therapist.

Which sections of F00098 apply to a manual wheelchair?

Sections I through VII: neurological factors, postural control, medical and surgical history, functional assessment, environmental assessment, requested equipment, and signatures. Power requests add Section VIII on power mobility and Section IX signatures. Every request also needs the Home Health/CCP Measuring Worksheet.

Why might an F00098 request be pended?

The form warns that if any portion is incomplete, the prior authorization request may be pended for additional information. Items to check before submitting include the QRP signature blocks, the measuring worksheet and the itemized retail price list for additions not in the base model price.