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Alabama Medicaid Form 384: Wheelchair Seating Eval

Alabama Medicaid requires Form 384 as an attachment to the Form 342 prior authorization request for wheelchairs. An Alabama-licensed physical or occupational therapist documents a full seating and mobility evaluation across seven pages: current chair, home and transportation, skin, daily activities, supine and sitting exam, strength and range of motion, balance and transfers, then item-by-item equipment recommendations with justification.

Who completes it

An Alabama-licensed PT or OT completes the evaluation and signs and dates each page. An assistive technology professional (ATP) signs page 7 to show involvement, and the vendor's name and NPI are recorded there. The DME provider submits Form 342 with the physician's prescription.

Submitting and payment

How to submit it
The DME provider attaches Form 384 to the Form 342 prior authorization request it submits to Alabama Medicaid.
Who pays
For adults, Alabama Medicaid reimburses the wheelchair evaluation only when the PT or OT is employed by a hospital enrolled with Alabama Medicaid and performs it in the hospital outpatient setting.

Good to know

  • Alabama Medicaid or its designee may ask for more information, including a trial of the requested wheelchair to see if the recipient can operate it independently; if no trial chair exists, justify that.
  • Fill in all appropriate blanks; NA is acceptable for any section that does not apply to the recipient.
  • The therapist attests on page 6 to having no financial relationship with the equipment supplier.
  • Page 7 is for comments that justify the equipment, such as changes in medical or functional status or growth. Alabama Medicaid warns typed text may be cut off when printed.

Get the official form

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

Wheelchair / Seating Evaluation

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 Alabama Medicaid Form 384?

An Alabama-licensed physical therapist or occupational therapist completes and signs the seating and mobility evaluation, with an ATP signing when involved. A physician's prescription is still required, and the DME provider files the request on Form 342 with Form 384 attached.

Does Alabama Medicaid pay for the wheelchair evaluation?

For adults, Medicaid pays for the PT or OT evaluation for manual wheelchairs with accessories and all power wheelchairs only when a therapist employed by an enrolled hospital performs it in the hospital outpatient setting. Evaluations done elsewhere for adults are not reimbursed.

What does the recommendations page of Form 384 ask for?

Each component with its justification: mobility base, electronics and method of driving, power seat functions, seat width and depth, seat frame heights, back support, lateral trunk supports, armrests, wheels and casters, leg and foot supports, cushions, positioning belts, head support and other accessories.