Streamline your Medicare billing and practice management with PtEverywhere.
Medicare provider enrollment is one of the most essential processes for physical therapy professionals and practice owners seeking to treat Medicare beneficiaries and receive reimbursement for services. However, navigating the maze of government systems, forms, and regulations can often feel overwhelming. That’s why understanding the Medicare provider enrollment application process from start to finish is key to ensuring compliance, avoiding costly delays, and optimizing the financial health of your physical therapy practice.
In this comprehensive guide, we’ll break down every element of the Medicare provider enrollment process—from acquiring your NPI number and submitting your Medicare provider enrollment forms, to managing your enrollment through PECOS and keeping your practice up to date.
For many physical therapy clinics and solo practitioners, Medicare patients make up a large portion of the patient base. Without proper enrollment as a Medicare provider or supplier, practitioners cannot bill for services rendered to Medicare beneficiaries.
Additionally, being properly enrolled ensures that:
Whether you’re starting a new practice, hiring additional physical therapists, or expanding locations, each step of your growth strategy must be supported by correct Medicare enrollment.
Before you can complete a Medicare provider enrollment application, you need a National Provider Identifier (NPI). This unique 10-digit number is required for all healthcare providers in the U.S.
To apply, visit the National Plan & Provider Enumeration System (NPPES). It usually takes a few days to receive your NPI once your application is submitted.
Pro tip: If you’re unsure whether you already have an NPI, you can verify it using the NPI Registry.
Once you have your NPI, the next step is to complete your Medicare provider enrollment forms. CMS (Centers for Medicare & Medicaid Services) offers two ways to submit these:
PECOS (Provider Enrollment, Chain, and Ownership System) is CMS’s online system that allows providers to:
Using PECOS reduces the risk of processing delays and errors. It is the preferred method for most physical therapists and practice owners.
Access PECOS at https://pecos.cms.hhs.gov
If you prefer or are required to submit your application by mail, you’ll need to complete the CMS-855I form for individuals or CMS-855B for group practices. These Medicare provider enrollment forms are longer, can be prone to errors, and generally take longer to process.
Depending on your provider type and practice structure, CMS may require you to pay an application fee. This applies especially to organizational providers. Individual physical therapists enrolling independently may not be required to pay a fee.
The fee can be paid online through the PECOS Fee Payment Portal.
Once your application is submitted, your assigned Medicare Administrative Contractor (MAC) will process it. They may:
Use the MAC contact list on the CMS website to determine who your contractor is and how to reach them. They are your point of contact for questions about your enrollment status or any issues during processing.
Once approved, you’re officially a Medicare provider—but your responsibilities don’t end there. To stay in good standing and maintain your billing privileges, you must keep your information current and revalidate your enrollment periodically.
Here’s what you need to know:
All updates can be made through PECOS. CMS recommends using PECOS for faster and more accurate record management.
CMS requires providers to revalidate their Medicare enrollment every 3-5 years. You will be notified by your MAC when your revalidation is due. Failure to revalidate can result in deactivation of your billing privileges.
Revalidation is completed in the same way as your initial Medicare provider enrollment application, ideally through PECOS.
As a physical therapist or clinic owner, staying compliant with Medicare isn't just about checking a box. It's about safeguarding your revenue stream, enhancing patient access, and ensuring operational efficiency. Mastering the process of Medicare provider enrollment and managing your Medicare provider enrollment forms ensures your practice is set up for long-term success.
But Medicare enrollment isn’t a one-and-done process. It’s an ongoing administrative responsibility that can drain time and focus away from your core mission—helping patients heal and thrive.
That’s where PtEverywhere comes in.
PtEverywhere’s integrated physical therapy software simplifies the enrollment and ongoing compliance process for Medicare providers by helping you:
All-in-one support for your physical therapy business—enrollment included.
Medicare provider enrollment may feel like a bureaucratic maze at first, but with the right guidance and tools, it becomes a manageable and necessary part of running a successful physical therapy practice.
By understanding how to apply, use, and maintain your enrollment—whether through PECOS or paper forms—you’re taking a major step toward securing steady reimbursement, enhancing your professional credibility, and serving a broader patient population.
Whether you’re a solo practitioner or managing multiple therapists under one roof, staying compliant with CMS guidelines is non-negotiable. And with PtEverywhere by your side, it doesn’t have to be stressful.
Make Medicare enrollment smoother. Make your practice unstoppable.