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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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Qualifications to be a Therapist in Private Practice

See our Medicare Enrollment Page.

In order to qualify to bill Medicare directly as a therapist, each individual must be enrolled as a private practitioner and employed in one of the following practice types:

  • An unincorporated solo practice,
  • Unincorporated partnership,
  • Unincorporated group practice,
  • Physician/NPP group or
  • Groups that are not professional corporations, if allowed by state and local law.

Physician/NPP group practices may employ TPP if state and local law permits this employee relationship.

A physician/NPP group practice is defined as one or more physicians/NPPs enrolled with Medicare who may bill as one entity.

Private practice also includes therapists who are practicing therapy as employees of another supplier, of a professional corporation or other incorporated therapy practice.

Private practice does not include individuals when they are working as employees of an institutional provider.


Medicare Benefit Manual Ch. 12 § 230.4

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Therapy Comply is a healthcare compliance firm that seeks to bring high quality web-based compliance guidance and one-on-one consulting services to small and medium size physical, occupational, and speech therapy practices.

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