Physical therapist (PT) in private practice

Qualification requirements

Physical therapists (PT) who are in private practice must meet the following applicable criteria to provide services for Medicare beneficiaries:

• Graduated after successful completion of a physical therapist education program approved by one of the following:
  • The Commission on Accreditation in Physical Therapy Education (CAPTE).
  • Successor organizations of CAPTE.
  • An education program outside the United States determined to be substantially equivalent to physical therapist entry-level education in the United States by a credentials evaluation organization approved by the American Physical Therapy Association (APTA) or other approved organization as it relates to physical therapists; and

• Passed an examination for physical therapists approved by the state in which physical therapy services are provided

  or

• On or before December 31, 2009--

  • Graduated after successful completion of a physical therapy curriculum approved by the CAPTE; or
  • Meets both of the following:
    • Graduated after successful completion of an education program determined to be substantially equivalent to physical therapist entry level education in the United States by a credentialed evaluation organization approved by the APTA or other approved organization as it relates to physical therapists; and
    • Passed an examination for physical therapists approved by the state in which physical therapy services are provided

  or

• Before January 1, 2008--

  • Graduated from a physical therapy curriculum approved by one of the following:
    • The APTA.
    • The Committee on Allied Health Education and Accreditation of the American Medical Association.
    • The Council on Medical Education of the American Medical Association and the APTA

  or

• On or before December 31, 1977, was licensed or qualified as a physical therapist and meets both of the following:

  • Has two years of appropriate experience as a physical therapist.
  • Has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service

  or

• Before January 1, 1966--

  • Was admitted to membership by the APTA; or
  • Was admitted to registration by the American Registry of Physical Therapists; or
  • Has graduated from a physical therapy curriculum in a four-year college or university approved by a state department of education

  or

• Before January 1, 1966, was licensed or registered, and before January 1, 1970, had 15 years of full-time experience in the treatment of illness or injury through the practice of physical therapy in which services were rendered under the order and direction of attending and referring doctors of medicine or osteopathy.

Documentation requirements and recommendations

• Completed CMS-855I form 
  
  Note: To expedite the processing of your provider enrollment application, you may use the internet-based PECOS, which will automatically select the appropriate form and allow you to complete the application process online.
• Signed and dated certification statement -- all signatures must be original and signed in ink (blue ink preferred). Stamped, faxed, or copied signatures will not be accepted. 
  
  Note: If you submitted your application through internet-based PECOS, you may sign the application electronically or you must submit your paper certification statement within 15 days of your electronic submission.
• Completed Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588) and associated documentation (e.g., copy of a voided check and / or a deposit slip). Please click here for more information. 
  
  Note: If a provider / supplier already receives payments electronically and is not making a change to his/her banking information, the CMS-588 is not required. In addition, physicians and non-physician practitioners who are reassigning their benefits to another entity are not required to submit the CMS-588.
• Include copies of the following supporting documents:
• A notarized copy or a certified “true copy” of the practitioner’s state medical license:
  • A notarized copy must include the stamp that states “official seal” and the name of the notary public as well as the state, county, and date the notary’s commission expires.
  • A certified “true copy” of an original document has a raised seal that identifies the state and county in which it originated or is stored.
    
    Note: A provider / supplier located in Puerto Rico or U.S. Virgin Islands must include a copy of his or her Letter of Good Standing. The letters for Puerto Rico providers / suppliers will be considered valid if it was issued within 12 months of First Coast’s receipt of the enrollment application. The letters for U.S. Virgin Islands providers / suppliers will be considered valid if it was issued within six months of First Coast’s receipt of the enrollment application.
• Certificate of completion, transcript, and/or diploma from accredited educational program(s) required for certification and/or licensure (please refer to Qualification requirements section at the top of the page.)

Additional documentation requirements (when applicable)

Medicare may require additional documentation, when applicable, to validate key information contained within the enrollment application (e.g., name change, tax identification number, proof of citizenship) or to address specific issues that could adversely affect a practitioner’s potential eligibility for enrollment (e.g., adverse legal actions, financial relationships).

• Driver’s license
• Social Security card
• Marriage license
• U.S. passport
• NPI verification from National Plan and Provider Enumeration System (NPPES) -- only durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers are required to submit this type of documentation
• Written confirmation from the IRS verifying provider’s TIN is associated with the provider’s legal business name (e.g., IRS CP 575)
• Final adverse action documentation: Please include copies of legal documents associated with any final adverse action(s) taken against the provider as well as copies of any legal documents showing its resolution (e.g., notifications, reinstatement letters).
  
  Note: Documents containing a summary of the adverse actions taken or their resolution will not be accepted.
• Completed Medicare Participating Physician or Supplier Agreement (CMS-460)
• Statement in writing from the practitioner’s bank (or other financial institution) -- if Medicare payments will be sent to a practitioner’s bank with which he or she has a lending relationship (i.e., any type of loan), then the practitioner must provide a statement in writing from the bank -- which must be specified in the loan agreement -- that the lender has agreed to waive its right of offset for Medicare receivables.