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.

CMS-855A

  • 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

CMS-588 EFT

  • 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:

  1. 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.
  2. Additional days after State and CMS approval Noridian will have additional days to finalize enrollment records.
Last Updated Nov 15 , 2024