Medicare enrollment for OTs, PTs, and SLPs: PECOS, the CMS-855I, and your MAC

CMS’s enrollment guide for providers and suppliers lays out four steps: get an NPI, complete the Medicare enrollment application in PECOS (or on a paper form), pay the application fee if one applies, and work with your Medicare Administrative Contractor (MAC). CMS’s Medicare Program Integrity Manual, Chapter 10, says individual practitioners use the Form CMS-855I and has separate sections for occupational therapists, physical therapists, and speech-language pathologists in private practice. The same chapter lists occupational therapist assistants and physical therapist assistants among those not eligible to enroll. No fee amounts are copied.

Quoted from official pages checked November 10, 2026. Confirm current requirements, fees, and dates on those sites. This page is not legal advice and does not guarantee eligibility, certification, or licensure.

Sources read on November 10, 2026: CMS’s Medicare Enrollment for Providers & Suppliers guide (page last modified June 2, 2026), CMS’s PECOS enrollment page, and the Medicare Program Integrity Manual, Chapter 10 – Medicare Enrollment (PDF; table of contents Rev. 13717, issued July 8, 2026). The PECOS application itself is a sign-in system and was not read. Getting an NPI is covered on NPI numbers; the private-practice rules themselves are on working in private practice.

CMS’s four steps

CMS’s guide begins: “Ready to become a Medicare provider or supplier? This guide will help you enroll in four steps.” It says to use the guide if, among other cases, “You’re a health care provider who wants to bill Medicare for your services and also have the ability to order and certify.” It is not for DMEPOS suppliers or institutional providers, which have their own CMS pages.

Get an NPI. “If you already have an NPI, skip this step and proceed to Step 2.” “NPIs are issued through the National Plan & Provider Enumeration System (NPPES).”
Complete the enrollment application. The guide calls PECOS the online Medicare enrollment system and says: “PECOS has video and print tutorials and will walk you through your enrollment to ensure your information is accurate.” It adds: “If you’re unable to apply online using PECOS, you can use a paper application form.” CMS posts the paper forms on its enrollment applications page.
Pay the application fee, if applicable. The guide says: “To determine whether an application fee is applicable, refer to Application Fee Matrix”. The amount is on CMS’s pages and is not copied here.
Work with your MAC. “Your Medicare Administrative Contractor (MAC) is specific to the region where you practice and may have additional requests for information while they process your application.”

On keeping enrollment current, the guide states: “To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days:” a change in ownership, an adverse legal action, and a change in practice location. It continues: “You must report all other changes within 90 days.”

The CMS-855 forms, as CMS describes them

Chapter 10 describes the Form CMS-855I, the Medicare Enrollment Application for Physicians and Non-Physician Practitioners: “This application should be completed by physicians and non-physician practitioners who render Medicare Part B services to beneficiaries.” It adds: “The CMS-855I captures reassignment information that was previously collected via the CMS-855R, which has been discontinued.”

Of the Form CMS-855B, for clinics, group practices, and certain other suppliers, it states: “This application should be completed by supplier organizations (e.g., ambulance companies) that will bill Medicare for Part B services furnished to Medicare beneficiaries. It is not used to enroll individuals.”

Occupational therapists in private practice

Section 10.2.3.9 states: “All occupational therapists in private practice must respond to the questions in Section 2J of the Form CMS-855I.” It continues: “However, Section 2J does not apply if the occupational therapist: (1) plans to provide services as a member of an established occupational therapist group, an employee of a physician-directed group, or an employee of a non-professional corporation; and (2) wishes to reassign benefits to that group.”

For home-only practices: “If the occupational therapist checks that all services are furnished in patients' homes, the contractor shall verify that the individual has an established private practice where the individual can be contacted directly and where the individual maintains patient records.” And: “Post office boxes are not acceptable.”

Physical therapists in private practice

Section 10.2.3.10 states: “All physical therapists in private practice must respond to the questions in Section 2J of the Form CMS-855I.” It also describes site visits: “If a physical therapist or physical therapist group submits an initial application for private practice, the contractor shall order a site visit through PECOS.” It adds: “The contractor shall not convey Medicare billing privileges to the supplier prior to the completion of the NSVC’s site visit and the contractor’s review of the results.”

Speech-language pathologists in private practice

Section 10.2.3.15 (Rev. 13415) states: “Accordingly, an individual must meet this definition of ‘qualified speech language pathologist’ to enroll as a speech language pathologist in private practice (SLPPP).” It also states: “Individuals should check the ‘Qualified Speech Language Pathologist’ box on the Form CMS-855I when enrolling as an SLPPP.”

Assistants

Section 10.2.8, Providers/Suppliers Not Eligible to Enroll, states that it “contains a non-exhaustive list of individuals and entities that frequently attempt to enroll in Medicare but are not eligible to enroll as one of the categories listed below.” The list includes “Occupational Therapist Assistant” and “Physical Therapist Assistant”. The section states: “If the contractor receives an enrollment application from an individual/entity attempting to enroll as one of these categories below, the contractor shall deny the application”.

That list, as read for this site, does not name speech-language pathology assistants, and this page makes no claim either way about SLPAs. How assistants work under a therapist’s supervision is on supervision.

What this page does not do

It does not copy application fees or processing times, does not say whether any therapist should enroll, opt out, or reassign benefits, and does not replace the PECOS instructions or your MAC. It is not legal, billing, or compliance advice. Confirm current rules with the agency that publishes them, your employer, and your state board.