OPT OSP - JE Part A
Outpatient Physical Therapy (OPT)/Outpatient Therapy/Speech Pathology Services (OSP)
On this page, view the below information.
Information is found in CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 10, Section 10.2.1.11
Three types of certified providers of OPT/OSP services
- Rehabilitation Agencies
- Furnish services in a team environment and in accordance with a "multidisciplinary" program to assist handicapped and disabled individuals
- Provide social or vocational adjustment services as well
- Majority of Part A OPT/OSP providers are rehabilitation agencies
- Clinics
- Created primarily for the provision of outpatient physician services
- Services must be furnished by a group of at least three physicians practicing medicine together, and at least one physician must be present in the clinic at all times to perform medical services
- Public Health Agency
- Created by a State or local government
- Primary purpose is to furnish environmental health services, preventive medical services and, in some instances, therapeutic services, as a means of sustaining the health of the general population
Billing for OPT/OSP
- For more information regarding billing, go to the billing portion of the website.
Application Requirements
PECOS application
- "Institutional Provider" (e.g., Hospital, Skilled Nursing Facility, Hospice, Home Health Agency)
- Complete questionnaire to ensure correct applications (CMS-855A and CMS 588-EFT) populate.
- Complete all form sections
- Attach all supporting documentation such as IRS documents
- List all directors, board members, and contracted or W-2 managing employee
- Visit the Application Fee webpage to access CMS link to pay application fee
- Submit completed CMS-588 EFT and voided check/bank letter. EIN required to be on application in Tax Identification Number (TIN) field
- May also furnish services in patient's homes, must include mobile services sections of the 855A application
- For an OPT/OSP provider to establish an extension location in an adjoining State, the two States involved must have a signed reciprocity agreement with each other allowing approval of the extension location. An extension location situated in a different State will bill under the primary site's provider number
Application Time Frame
Application Type | Processing Time |
---|---|
PECOS | On average, it can take 15 to 50 calendar days before application is sent to state and CMS for approval |
Paper | On average, it can take 30 to 65 calendar days before application is sent to state and CMS for approval |
Note:
- Once Noridian has completed the reviewal of the application, a Recommendation for Approval Letter is sent to the State Agency and CMS. There is no set timeframe for their review.
- Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.