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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Enrollment Criteria for SLPs

In order to qualify as an outpatient speech-language pathologist in private practice, an individual must meet the following requirements:

Be legally authorized (if applicable, licensed, certified, or registered) to engage in the private practice of speech-language pathology by the state in which he or she practices, and practice only within the scope of his or her license and/or certification.

Engage in the private practice of speech-language pathology on a regular basis as an individual in one of the following practice types:

    • A solo practice,
    • Partnership,
    • Group practice, or
    • As an employee of one of these.

Bill Medicare only for services furnished in one of the following:

    • A speech-language pathologist's private practice office space that meets all of the following:
      • The location(s) where the practice is operated, in the state(s) where the therapist (and practice, if applicable) is legally authorized to furnish services and during the hours that the therapist engages in practice at that location; and
      • The space must be owned, leased, or rented by the practice, and used for the exclusive purpose of operating the practice; or
    • A patient's home not including any institution that is a hospital, a CAH, or a SNF.

Treat individuals who are patients of the practice and for whom the practice collects fees for the services furnished.

Reference

Medicare Program Integrity Manual

Chapter 10 – Medicare Enrollment 10.2.3.15

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