Physical Therapy Credentialing
Medicare Part B supplier enrollment, per-payer credentialing, and the re-credentialing cycle for PT practices.
The short answer: physical therapists enroll with Medicare as Part B suppliers through PECOS, and must credential separately with Medicaid and every commercial payer — most pulling from CAQH but each verifying independently. Medicare credentialing runs ~90 days; re-credentialing recurs every 2–3 years and is the most commonly missed deadline.
Key takeaways
- PTs are Medicare Part B suppliers; enrollment is via PECOS.
- Credential separately with Medicare, Medicaid, and each commercial payer — no single application covers all.
- CAQH ProView is the common data source; each payer still runs its own verification.
- Re-credentialing every 2–3 years — a missed deadline drops you from the network.
- PTAs bill under the supervising PT; enrollment is built around the licensed PT.
Foundations: credentialing vs paneling vs payer enrollment · how to get on insurance panels. This page is the overview — for the full step-by-step how-to, read the complete PT credentialing guide.
What a PT practice has to run
New practice owners underestimate how many parallel enrollments this is. Each payer is its own track with its own clock.
Medicare (PECOS, Part B supplier)
Enroll the PT and the practice via PECOS. Credentialing ~90 days; reassignment/enrollment often 15–35 days with limited backdating to the effective date.
Medicaid (state-specific)
Separate enrollment per state Medicaid program, often through a managed-care layer with its own document set and timeline.
Commercial payers
Credential individually with each carrier you accept. CAQH feeds them, but each runs its own verification and may request extras.
Re-credentialing cycle
Every 2–3 years per payer. Track deadlines proactively — a lapse drops you from the network and stops payment mid-cycle.
Deeper: the complete PT credentialing guide · timeline by payer.
How PayerReady handles PT practices
A dedicated specialist runs the Medicare Part B enrollment, every commercial credentialing track, and CAQH attestation in parallel — then automated expirables monitoring tracks every re-credentialing deadline so you never drop from a network mid-cycle. One dashboard, real-time status, built for new and growing PT practices.
Frequently asked questions
Physical therapists are classified as Part B suppliers for Medicare and enroll through PECOS. Credentialing typically takes about 90 days; the enrollment/reassignment portion often completes in roughly 15–35 days, and Medicare effective dates can allow limited backdated billing.
Yes. Credentialing must be completed separately with Medicare, Medicaid, and each commercial payer you plan to accept. Most commercial payers use CAQH ProView as the common data source, but each still runs its own verification and may request additional documents.
Most payers require re-credentialing every two to three years. Missing a re-credentialing deadline can drop you from the network and interrupt billing, so deadlines should be tracked actively, not reactively.
Physical therapist assistants work under PT supervision and do not enroll as independent billing providers; services are billed under the supervising PT subject to payer and Medicare supervision and modifier rules. Enrollment is built around the licensed PT, not the PTA.
A Type 1 NPI (and Type 2 for the practice entity), state PT license, malpractice coverage, W-9/Tax ID, an attested CAQH ProView profile, and practice location details. Expect to assemble roughly 30 documents per provider across payers.
Primary sources
- CMS — Therapy services (PT/OT/SLP)
- CMS — Medicare provider enrollment (MLN booklet)
- Medicare PECOS — provider enrollment system
- CAQH ProView — provider data portal
Regulations change. Report an inaccuracy to credentialing@payerready.com — corrected within 48 hours.
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