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Georgia - Physical Therapy Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Georgia State Board of Physical Therapy licenses practitioners to deliver Physical Therapy Services, which are funded for adult beneficiaries through the Comprehensive Supports Waiver Program (COMP) operated by the Department of Behavioral Health and Developmental Disabilities (DBHDD). Under the COMP waiver, these services are strictly limited to individuals who have reached their 21st birthday and must be explicitly ordered by a physician and reflected in a Regional Office-approved Individual Service Plan (ISP).

Agencies and independent practitioners seeking reimbursement must complete a dual-enrollment process, submitting one application to the Department of Community Health (DCH) via the GAMMIS portal and a separate provider application directly to DBHDD. Outpatient therapy clinics are categorized as Moderate Categorical Risk by DCH, mandating an unannounced pre-enrollment or post-enrollment site visit before the Medicaid Provider Number (MPN) is fully activated.

1. Service Definition and Scope

In Georgia's COMP waiver, Physical Therapy Services encompass evaluation, therapeutic procedures, and exercises designed to develop strength, endurance, range of motion, and flexibility. Services may be delivered in the participant's home, a PT office, outpatient clinics, Supported Employment work sites, or other community settings.

The service is strictly governed by special eligibility conditions, most notably that it is not available to waiver participants until their 21st birthday. A licensed physical therapist must document a reasonable expectation that the person can achieve the specified goals within a necessary timeframe.

2. Regulatory and Oversight Agencies

The Georgia Department of Community Health (DCH) serves as the State Medicaid Agency, overseeing the waiver and managing the centralized credentialing and reimbursement systems. The Department of Behavioral Health and Developmental Disabilities (DBHDD) operates the COMP waiver day-to-day, handling participant assessments, level of care determinations, and waiver provider certification.

Professional licensure is governed by the Georgia State Board of Physical Therapy under the Secretary of State. Provider enrollment and claims processing are managed through the Georgia Medicaid Management Information System (GAMMIS).

3. Gatekeeping Prerequisites: Who Can Even Apply

Georgia does not require a Certificate of Need (CON) for independent physical therapy clinics, nor are there closed network moratoria or competitive procurement (RFP) requirements to become a COMP waiver PT provider. However, structural prerequisites exist regarding dual-agency approval.

To participate in the COMP waiver, an applicant must submit two separate provider applications: one to DCH for Medicaid enrollment and one to DBHDD for waiver certification. There is no requirement to subcontract under a designated network entity, but DBHDD certification requires a site visit to review the organization and its programs before approval is granted.

4. Licensure and Certification Requirements

Individual physical therapists must hold an active license from the Georgia State Board of Physical Therapy. The licensure process requires passing the National Physical Therapy Examination (NPTE) and submitting to a criminal background check.

Applicants must provide verification of education and, if licensed in other states, verification of those licenses. The Board requires applicants to register online for the NPTE via the Federation of State Boards of Physical Therapy (FSBPT) before eligibility to test is granted.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the GAMMIS portal using a 12-step Enrollment Wizard. Outpatient therapy clinics are designated as Moderate Categorical Risk under 42 CFR 455.450, which mandates an unannounced pre-enrollment or post-enrollment site visit by DCH or its agents.

Institutional providers must pay an application fee, though individual physicians and non-physician practitioners (NPPs) are exempt. The license name, number, and expiration date on the GAMMIS application must exactly match Georgia state records to avoid rejection.

6. Staffing, Training and Background Checks

All physical therapy services must be delivered by or under the direct supervision of a physical therapist licensed by the Georgia State Board of Physical Therapy. The state requires comprehensive background screening for all licensed personnel.

During the licensure process, applicants must complete a Name-Based Criminal History Record Information Consent/Inquiry Form and submit fingerprints via the Fieldprint-GAPS system. DBHDD also requires providers to adhere to its Core Requirements for Providers regarding staff training and qualifications.

7. Documentation, Policies and Records

Providers must maintain a master credentialing file with current versions of all licenses and organizational documents. DCH requires exact matching of Tax Identification Numbers (TIN) with IRS records on the W-9 form.

Under 42 CFR 455.104, providers must submit an Ownership and Controlling Interest Disclosure listing every person with 5 percent or more direct or indirect ownership. Group practices must provide Articles of Incorporation or an Operating Agreement.

8. Billing, Rates and Claims

Once approved, DCH assigns a Medicaid Provider Number (MPN), which is required to bill claims directly to DCH or any Georgia Families Care Management Organization (CMO). All COMP waiver participant services require Prior Approval (PA) by DBHDD.

The PA must be entered into the Medicaid Management Information System (GAMMIS). All claims pay strictly according to the parameters and limits specified on the waiver participant's approved PA.

9. Approval Sequence and Timeline

The approval sequence begins with obtaining professional licensure from the Georgia State Board of Physical Therapy. Following licensure, the provider submits the DCH Medicaid enrollment application via GAMMIS and the DBHDD waiver application simultaneously.

Limited risk screening for individual practitioners typically completes within 15 business days. However, outpatient clinics subject to Moderate risk screening and DBHDD site visits will experience longer timelines. Welcome Letters and PIN Letters are typically received 5 to 7 business days post-approval.

10. Common Denials and Survey Findings

A primary cause of application rejection in Georgia is data mismatch; the license name, number, and expiration date must exactly match Georgia state records on the GAMMIS application. TIN mismatches on the W-9 also cause federal database verification failures.

For licensure, applications are voided if deficiencies are not corrected within 60 days of notification. DBHDD certification may be delayed or denied if the required site visit reveals inadequate infrastructure or failure to meet Core Requirements for Providers.

11. Key Contacts and Resources

Providers must utilize the GAMMIS portal for enrollment and claims, and the Secretary of State's portal for licensure. DBHDD provides the COMP Ready Reference Provider Guide for waiver-specific policies.

For application tracking, providers should reference their ATN when contacting Gainwell Technologies, the state's fiscal agent.

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