Physical Therapist Enrollment Criteria and Forms

Revised: December 6, 2024

To enroll as a physical therapist (PT) with Minnesota Health Care Programs (MHCP), the PT must:

· Be licensed by the American Physical Therapy Association or its equivalent.

· Maintain applicable state licensure requirements or compliance with state regulatory requirements in states that do not license.

· Graduate after successful completion of a physical therapy education program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) or its equivalent.

· Pass an examination for physical therapists approved by the state in which the physical therapy services are provided.

· Be enrolled with Medicare.

How to Enroll

Physical therapy providers who wish to enroll with MHCP or make enrollment requests can do so in one of the following two ways.

Online MPSE Portal

Register to access the Minnesota Provider Screening and Enrollment (MPSE) portal and complete your enrollment online using the MPSE portal. If enrolling through the MPSE portal, you are required to upload the following:

· Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF) (DHS-4138) (PDF)

· Copy of the PT license

or

Submit Forms via Fax

Complete the following documents and fax your materials to MHCP Provider Eligibility and Compliance at 651-431-7462.

· Individual – Provider Enrollment Application (DHS-4016) (PDF)

· Fee-for-Service (FFS) only or FFS and Managed Care Organization In-Network Provider Agreement (DHS-4138) (PDF)

· Copy of PT license

Review and keep a copy of the MHCP Data Privacy Notice (DHS-6287) (PDF).

We process forms in order by the date received. Whether enrolling using the MPSE portal or by fax, allow 30 days for processing. If we need more information to complete your enrollment, we will send a request for more information letter via U.S. Postal Service (or your MN–ITS mailbox, if you have an account) explaining what you need to do to complete your enrollment.

Revalidation

MHCP is required to follow the Centers for Medicare & Medicaid Services (CMS) final federal provider screening regulations.

Refer to Revalidation in the Provider Screening Requirements section of the MHCP Provider Manual for more information about how to complete your revalidation.

Reporting Changes

Report any changes made on a provider record to MHCP Provider Eligibility and Compliance. Refer to Changes to Enrollment in the Enroll with MHCP section of the MHCP Provider Manual for details.

Additional Resources

Minnesota Statutes, 148.65-148.78 (Physical Therapists)
Minnesota Rules, 9505.0390 (Rehabilitative and Therapeutic Services)
Minnesota Rules, 9505.0391 (Therapists Eligible to Enroll as Providers)
Code of Federal Regulations, title 42, section 410.60 (Outpatient Physical Therapy Services: Conditions)