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

Last reviewed: 2026-09-10

The Nebraska Department of Health and Human Services (DHHS) Division of Public Health licenses physical therapists under Title 172 NAC 137, while the Division of Medicaid and Long-Term Care (MLTC) enrolls them to provide Home and Community-Based Services (HCBS) under the Aged and Disabled, Traumatic Brain Injury, and Developmental Disabilities waivers. Approval requires practitioners to first secure an active state physical therapy license, which mandates passing the Nebraska Physical Therapy Jurisprudence Examination, before they can apply for Medicaid billing privileges.

Once licensed, providers must submit a Form MC-19 Nebraska Service Provider Agreement through the Maximus Provider Data Management System (PDMS). Nebraska does not require a Certificate of Need or regional network procurement for independent physical therapy providers, making the primary structural prerequisite the completion of professional licensure and the subsequent fee-for-service Medicaid enrollment.

1. Service Definition and Scope

In Nebraska Medicaid HCBS waivers, physical therapy services include licensed evaluation and treatment addressing mobility, strength, balance, and fall risk for waiver participants. Services must be ordered by a physician and provided according to a formal Plan of Care utilizing American Physical Therapy Association (APTA) guidelines.

Physical therapy assistants may provide services under the general supervision of a licensed physical therapist, who may supervise no more than two assistants concurrently. Services are delivered in the participant's home or community setting to maintain or improve functional mobility.

2. Regulatory and Oversight Agencies

The Nebraska Department of Health and Human Services (DHHS) divides oversight between professional licensure and Medicaid enrollment. The Division of Public Health handles the credentialing of physical therapists and assistants.

The Division of Medicaid and Long-Term Care (MLTC) manages waiver operations and provider enrollment, utilizing Maximus as its enrollment contractor for the Provider Data Management System (PDMS).

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska operates an open enrollment model for Medicaid physical therapy providers, meaning there are no closed networks, moratoria, or Certificate of Need (CON) requirements blocking entry. The absolute structural precondition is holding an active Nebraska Physical Therapy license.

Providers cannot submit a Medicaid enrollment application without first obtaining this state license and a National Provider Identifier (NPI). Out-of-state providers must hold equivalent licensure and pass the Nebraska jurisprudence exam to practice within the state.

4. Licensure and Certification Requirements

Physical therapists must be licensed under Title 172 NAC 137 by the DHHS Division of Public Health. Applicants must graduate from a CAPTE-accredited program and pass the National Physical Therapy Examination (NPTE).

Additionally, Nebraska strictly requires passing a state-specific Jurisprudence Examination covering the Physical Therapy Practice Act. Licenses must be renewed biennially with proof of continuing competency.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed electronically through the Maximus Nebraska Provider Data Management System (PDMS). Effective June 2025, Nebraska Medicaid will no longer accept paper applications.

Providers must complete Form MC-19 (Nebraska Service Provider Agreement) and submit required tax documents. Each physical location where services are provided must be enrolled separately.

6. Staffing, Training and Background Checks

All physical therapy staff must clear background checks through the Nebraska Child and Adult Abuse and Neglect Registry. Agencies must ensure all employed therapists and assistants maintain active, unencumbered licenses.

Physical therapy aides may perform non-treatment-related tasks but must be trained and directed by a licensed physical therapist. Clinical instructors may supervise physical therapist assistant students.

7. Documentation, Policies and Records

Providers must maintain clinical records that include the physician's order, the initial evaluation, the Plan of Care, and daily treatment notes. Documentation must align with APTA guidelines.

HCBS providers are subject to the HCBS and PAS Agency Policy and Procedure Review by DHHS. Records must be retained for a minimum of five years and made available for state or federal audit upon request.

8. Billing, Rates and Claims

Physical therapy services are reimbursed under the Fee-for-Service (FFS) model based on the Nebraska Medicaid Provider Rates and Fee Schedules. Claims are submitted electronically via the Maximus PDMS or an approved clearinghouse.

Providers must bill using standard CPT codes for physical therapy evaluations and modalities. Prior authorization may be required for extended treatment plans beyond initial limits.

9. Approval Sequence and Timeline

The approval sequence begins with obtaining the state physical therapy license, which requires passing the NPTE and state jurisprudence exams. Once licensed, the provider submits the MC-19 enrollment application via Maximus.

Maximus screens the application and forwards it to the DHHS Provider Relations team for final approval. The entire process typically takes 60 to 90 days from initial license application to active Medicaid billing status.

10. Common Denials and Survey Findings

Medicaid enrollment applications are frequently delayed or denied due to mismatched legal names between the IRS W-9/W-4 forms and the provider's NPI registry data. Failure to enroll each physical location separately also triggers rejections.

During audits, common findings include missing physician orders for the Plan of Care, inadequate documentation of supervision for physical therapist assistants, and failure to complete required Child/Adult Abuse Registry checks.

11. Key Contacts and Resources

Providers should direct licensure questions to the DHHS Licensure Unit and Medicaid enrollment questions to Maximus Customer Service. The Maximus portal is the central hub for all enrollment and revalidation activities.

The DHHS website hosts the official fee schedules, provider handbooks, and Title 172 NAC 137 regulations governing physical therapy practice in Nebraska.

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