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

Last reviewed: 2026-09-10

The Louisiana Department of Health (LDH) Health Standards Section (HSS) processes federal Medicare and Medicaid certification for Outpatient Physical Therapy (OPT) agencies, as the state of Louisiana does not issue a distinct state license for this facility type. Individual physical therapists and therapy groups bypass facility certification and enroll directly as independent practitioners using the PT-35 enrollment packet.

Facility-based OPT applicants must secure Office of State Fire Marshal approval for their physical site, including a mandated fire alarm system inspection, before HSS will accept the initial Title XVIII/XIX certification application. Independent practitioners must hold active, unencumbered licensure from the Louisiana Physical Therapy Board prior to submitting their Basic Provider Enrollment Packet to Gainwell Technologies.

1. Service Definition and Scope

In Louisiana Medicaid, physical therapy services encompass licensed evaluation and treatment addressing mobility, strength, balance, and fall risk for beneficiaries of all ages. Services may be delivered by independent practitioners, therapy groups, or certified Outpatient Physical Therapy (OPT) rehabilitation agencies.

OPT providers must offer a rehabilitation program that, in addition to physical therapy, provides social or vocational adjustment services. Extension locations are permitted if they are located sufficiently close to the primary site to share administration and supervision.

• Service Modalities: Therapeutic exercise, gait training, manual therapy, and neuromuscular re-education.
• OPT Definition: A federally certified rehabilitation agency providing PT and social/vocational adjustment services.
• Extension Locations: Permitted under a primary site's certification if geographically proximate.
• Age Limits: Services are available to Medicaid beneficiaries of any age without arbitrary age restrictions.
• Prior Authorization: Required for most non-evaluative treatment visits beyond initial thresholds.
• Excluded Providers: Physical Therapy Assistants (PTAs) cannot enroll independently in Louisiana Medicaid.

2. Regulatory and Oversight Agencies

Because Louisiana does not state-license OPTs, regulatory oversight is split between federal certification authorities, individual professional boards, and the Medicaid fiscal intermediary. The LDH Health Standards Section acts as the state survey agency for CMS.

Medicaid enrollment and claims processing are managed by Gainwell Technologies, while individual clinical practice is governed by the state physical therapy board.

• LDH Health Standards Section (HSS): Conducts federal certification surveys for OPTs (https://ldh.la.gov/health-standards-section).
• Louisiana Physical Therapy Board (LPTB): Issues and regulates individual PT and PTA licenses (https://www.laptboard.org).
• Gainwell Technologies: Manages the Louisiana Medicaid Provider Enrollment Portal and MMIS (https://www.lamedicaid.com).
• Office of State Fire Marshal: Approves facility plans and conducts mandatory life safety inspections (https://lasfm.la.gov).
• Centers for Medicare & Medicaid Services (CMS): Grants final federal OPT certification (https://www.cms.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Louisiana does not require a Facility Need Review (FNR) or Certificate of Need (CON) for Outpatient Physical Therapy agencies. The primary structural precondition for facility-based OPTs is physical plant approval by the Office of State Fire Marshal.

Individual practitioners face no network moratoria for fee-for-service Medicaid, but must possess an active National Provider Identifier (NPI) and an active Louisiana professional license before the enrollment portal will accept their application.

• Facility Need Review (FNR): Not required for OPTs in Louisiana.
• State Fire Marshal Approval: Mandatory prerequisite for OPT facility certification; requires an internally audible fire alarm system with a pull station.
• NPI Requirement: Applications submitted to Gainwell without a valid NPI are immediately rejected.
• Professional Licensure: Individual PTs must hold an active LPTB license before applying.
• Medicare Enrollment: OPT facilities must submit the CMS-855A to their Medicare Administrative Contractor (MAC) before HSS will conduct a survey.
• MCO Contracting: Required separately after fee-for-service enrollment to serve managed care populations.

4. Licensure and Certification Requirements

The Outpatient Physical Therapy Provider Program is a federally certified-only program in Louisiana. There are no state licensing regulations linked to this provider type; instead, facilities must meet the federal Conditions of Participation (42 CFR Part 485 Subpart H).

Applicants must submit an Initial Certification packet to HSS, which includes federal forms and attestations of compliance with civil rights and emergency preparedness mandates.

• State License: None issued; OPTs operate strictly under federal certification in Louisiana.
• Federal Regulation: Must comply with 42 CFR § 485.701 (Conditions of Participation for Clinics and Rehabilitation Agencies).
• CMS Form 1893: Outpatient Physical Therapy and/or Speech Pathology Request to Establish Eligibility.
• HHS Form 690: Assurance of Compliance with civil rights regulations.
• Emergency Preparedness: Must submit an attestation of compliance with CMS emergency preparedness rules.
• Individual PT License: Required for all practicing therapists, renewed biennially with the LPTB.

5. Medicaid Provider Enrollment

Enrolling in Louisiana Medicaid is a two-step process managed by Gainwell Technologies. Providers must submit both a Basic Enrollment Packet and a provider-specific packet.

Individual therapists and therapy groups use the PT-35 packet. All required documentation must be submitted as a single, complete application to avoid immediate rejection.

• Basic Enrollment Packet: Required for all new entities or individuals (Basic Provider Enrollment Packet for Entities/Businesses 11/24).
• Provider-Specific Packet: PT-35 Physical Therapist (Individual) or PT-35 Physical Therapist (Group).
• Application Portal: Forms are downloaded from lamedicaid.com and submitted to Gainwell Technologies.
• Application Fee: Required for institutional providers (OPTs) unless waived by Medicare enrollment; individual PTs are typically exempt.
• EFT Authorization: Mandatory direct deposit form must be included in the enrollment packet.
• NPI Linkage: The provider's NPI must be explicitly linked to the Louisiana Medicaid ID upon approval.

6. Staffing, Training and Background Checks

Staffing requirements depend on the enrollment type. OPT facilities must employ qualified personnel to provide physical therapy and the required social or vocational adjustment services.

All licensed personnel must undergo criminal background checks as part of their professional board licensure, and facilities must screen staff against state and federal exclusion lists.

• Clinical Director: OPTs must designate a qualified professional to supervise clinical services.
• PT Qualifications: Must hold a valid license from the Louisiana Physical Therapy Board.
• Social/Vocational Staff: OPTs must have qualified staff to evaluate social/vocational factors and provide counseling.
• Background Checks: Conducted via the Louisiana State Police for professional licensure.
• Exclusion Screening: Monthly checks required against the OIG LEIE and Louisiana Adverse Actions List.
• CPR Certification: All patient-facing clinical staff must maintain active Basic Life Support (BLS) certification.

7. Documentation, Policies and Records

Providers must maintain comprehensive clinical and administrative records that comply with both Louisiana Medicaid policy and, for OPTs, federal Conditions of Participation.

Treatment plans must be established by a physician or the physical therapist and reviewed at least every 30 days for facility-based OPT services.

• Plan of Care: Must include diagnoses, long-term goals, type, amount, frequency, and duration of services.
• Physician Sign-off: Required for the initial plan of care and subsequent revisions.
• Progress Notes: Must be written by the treating PT for every visit, detailing interventions and patient response.
• Emergency Plan: OPTs must maintain a documented emergency preparedness plan updated annually.
• Record Retention: Clinical and billing records must be retained for a minimum of six years from the date of service.
• Discharge Summary: Required upon completion of therapy, detailing goal achievement and future recommendations.

8. Billing, Rates and Claims

Physical therapy services are billed using standard CPT codes (e.g., 97110, 97116, 97161) on a CMS-1500 form for individuals or a UB-04 for facilities. Rates are published on the Louisiana Medicaid fee schedule.

While fee-for-service rates are set by LDH, the majority of Medicaid beneficiaries are enrolled in Healthy Louisiana managed care organizations (MCOs), which pay contracted rates.

• Fee Schedule: Published by Gainwell Technologies on lamedicaid.com under 'Fee Schedules'.
• Billing System: Claims are submitted electronically via the Gainwell MMIS portal or clearinghouse.
• Prior Authorization: Managed by the beneficiary's specific Healthy Louisiana MCO or the FFS utilization management contractor.
• Modifiers: Appropriate modifiers (e.g., GP for physical therapy) must be appended to claim lines.
• Time-Based Codes: Billed according to the 8-minute rule for direct, one-on-one contact.
• MCO Billing: Claims for managed care enrollees must be submitted directly to the respective MCO (e.g., Aetna, Bayou Health).

9. Approval Sequence and Timeline

The approval sequence for an OPT facility begins with physical plant readiness and ends with Medicaid enrollment. Individual practitioners skip the facility steps and proceed directly to Medicaid enrollment after obtaining their professional license.

The entire process for a facility can take 6 to 9 months, heavily dependent on Fire Marshal inspection scheduling and Medicare MAC processing times.

• Step 1: Obtain LPTB professional licensure (Individuals) or secure commercial space (Facilities).
• Step 2: Office of State Fire Marshal inspection and approval (Facilities only).
• Step 3: Submit CMS-855A to the Medicare MAC and Initial Certification packet to LDH HSS (Facilities only).
• Step 4: HSS conducts the initial unannounced certification survey (Facilities only).
• Step 5: Submit Basic and PT-35 Enrollment Packets to Gainwell Technologies (All providers).
• Step 6: Credential and contract with Healthy Louisiana MCOs (All providers).

10. Common Denials and Survey Findings

Medicaid enrollment applications are frequently rejected at the intake stage due to missing NPIs or incomplete Basic Enrollment Packets. Gainwell requires all forms to be submitted as a single, unified packet.

For OPT facilities, HSS survey deficiencies most commonly relate to life safety code violations or incomplete emergency preparedness documentation.

• Missing NPI: Automatic rejection of the Gainwell enrollment application.
• Fragmented Submissions: Sending required enrollment documents separately results in application return.
• Fire Alarm Deficiencies: Failure to have an internally audible pull-station alarm blocks HSS survey scheduling.
• Incomplete Emergency Plans: Failure to meet the CMS emergency preparedness attestation requirements.
• Outdated Forms: Using old versions of the PT-35 or Basic Enrollment Packet instead of the current 11/24 versions.
• Unsigned Plans of Care: A leading cause of post-payment claim recoupment during audits.

11. Key Contacts and Resources

Providers should rely on the official LDH Health Standards Section and Gainwell Technologies portals for the most current forms, fee schedules, and regulatory updates.

For individual licensure questions, the Louisiana Physical Therapy Board is the primary contact.

• LDH Health Standards Section (OPT): https://ldh.la.gov/health-standards-section/outpatient-physical-therapy-opt
• Louisiana Medicaid Provider Enrollment (Gainwell): https://www.lamedicaid.com/provweb1/provider_enrollment/newenrollments.htm
• Louisiana Physical Therapy Board: https://www.laptboard.org
• Office of State Fire Marshal: https://lasfm.la.gov (Phone: 225-925-4920)
• Gainwell Provider Enrollment Support: Phone: 1-877-598-8753
• Healthy Louisiana (MCO Information): https://myplan.healthy.la.gov

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