TMPPM 2009 > Texas Medicaid Services > Physical Therapists/Independent Practitioners > Enrollment

35.1 Enrollment

To enroll in Texas Medicaid, licensed physical therapists must be enrolled in Medicare.

The Medicare enrollment requirement is waived for therapists that only provide services to Texas Health Steps (THSteps)-eligible clients who are 20 years of age or younger and who do not receive Medicare benefits. These therapists must enroll as individuals.

If providers are currently enrolled with Texas Medicaid or plan to provide regular acute care services to clients with Medicaid coverage, enrollment in the THSteps-Comprehensive Care Program (CCP) is not necessary. All non-CCP physical therapy (PT) services must be billed with the current provider identifier.

Providers cannot be enrolled if their license is due to expire within 30 days of application. A current license must be submitted.

Important: All providers are required to read and comply with Section 1, Provider Enrollment and Responsibilities. In addition to required compliance with all requirements specific to Texas Medicaid, it is a violation of Texas Medicaid Program rules when a provider fails to provide health-care services or items to Medicaid clients in accordance with accepted medical community standards and standards that govern occupations, as explained in Title 1 Texas Administrative Code (TAC) §371.1617(a)(6)(A). Accordingly, in addition to being subject to sanctions for failure to comply with the requirements that are specific to Texas Medicaid, providers can also be subject to Texas Medicaid Program sanctions for failure, at all times, to deliver health-care items and services to Medicaid clients in full accordance with all applicable licensure and certification requirements including, without limitation, those related to documentation and record maintenance.

Refer to: "Provider Enrollment" for more information about enrollment procedures.

"THSteps-CCP Overview" for more information about providing services to Medicaid/THSteps clients.

"Texas Medicaid (Title XIX) Home Health Services" for more information about providing services to clients in the home setting.

"Managed Care" .