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

Last reviewed: 2026-09-10

The North Dakota Department of Health and Human Services (ND HHS) covers Physical Therapy services under the Medicaid State Plan, requiring providers to first secure an active professional license from the North Dakota Board of Physical Therapy before initiating any billing enrollment. Physical therapy evaluations and treatments addressing mobility, strength, balance, and fall risk are reimbursed on a fee-for-service basis, subject to specific service authorizations once annual visit limits are reached.

Approval to bill ND Medicaid mandates the submission of an electronic application through the North Dakota MMIS Web Portal, which is processed by the state's contractor, Noridian Healthcare Solutions. An applicant's National Provider Identifier (NPI) and state license must be fully active prior to portal submission, as the state strictly limits retroactive enrollment effective dates to no more than 90 days prior to the receipt of a complete application packet.

1. Service Definition and Scope

In North Dakota Medicaid, Physical Therapy encompasses medically necessary services provided to eligible members to restore, maintain, or improve physical functioning lost due to illness, injury, or congenital defect. Services must be ordered by a physician or other authorized practitioner and delivered by a licensed physical therapist or a licensed physical therapist assistant under appropriate supervision.

The scope of practice includes initial evaluations, the development of a formal plan of care, therapeutic exercises, gait training, and modalities aimed at reducing fall risk and improving balance. ND Medicaid requires that all interventions be directly tied to functional goals documented in the member's medical record.

• Service Modalities: Includes therapeutic exercise, neuromuscular re-education, and manual therapy techniques.
• Medical Necessity: Services must be clinically justified to treat a specific diagnosis or functional deficit.
• Ordering Practitioner: Requires a referral or order from a physician, physician assistant, or advanced practice registered nurse.
• Plan of Care: Must be established prior to treatment and updated regularly based on patient progress.
• Telehealth: Permitted for certain PT services if the provider complies with ND licensing requirements and submits the OOS Telehealth Attestation if located out of state.

2. Regulatory and Oversight Agencies

The primary oversight for Medicaid policy, coverage, and provider enrollment is managed by the North Dakota Department of Health and Human Services (ND HHS) Medical Services Division. They contract with Noridian Healthcare Solutions to process all standard provider enrollment applications and revalidations.

Professional licensure and practice standards are strictly regulated by the North Dakota Board of Physical Therapy. This board issues the credentials required to legally practice and bill for physical therapy services within the state.

• North Dakota Department of Health and Human Services (ND HHS): https://www.hhs.nd.gov/
• ND Medicaid Provider Enrollment Portal (MMIS): https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment
• North Dakota Board of Physical Therapy: https://www.ndbpt.org/
• Noridian Healthcare Solutions: https://www.noridian.com/

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota does not require a Certificate of Need (CON) or regional board sponsorship for independent physical therapy practices. The state operates an open enrollment model for Medicaid fee-for-service PT providers, meaning there are no closed networks or procurement-only access windows blocking new applicants.

The absolute structural precondition for enrollment is holding an active, unencumbered Physical Therapist license issued by the North Dakota Board of Physical Therapy. Without this license and a corresponding National Provider Identifier (NPI), the ND MMIS Web Portal will automatically reject the enrollment application.

• Professional Licensure: Must hold an active ND Physical Therapist license from the North Dakota Board of Physical Therapy.
• National Provider Identifier (NPI): Must be obtained from the NPPES registry prior to Medicaid application.
• Business Registration: Group practices must be registered with the North Dakota Secretary of State.
• Network Status: Open enrollment; no managed care contracting prerequisites exist for standard fee-for-service Medicaid.
• Out-of-State Providers: Must submit the OOS Telehealth Attestation if providing services remotely to ND members.

4. Licensure and Certification Requirements

To obtain a license from the North Dakota Board of Physical Therapy, applicants must graduate from a CAPTE-accredited physical therapy program and pass the National Physical Therapy Examination (NPTE). The board also requires applicants to pass a state jurisprudence examination covering North Dakota specific laws and administrative rules.

Licenses must be renewed annually. The board mandates continuing competence activities, requiring physical therapists to complete a specified number of continuing education units (CEUs) during each renewal cycle to maintain active status.

• Education: Graduation from a CAPTE-accredited physical therapy education program.
• National Exam: Passing score on the NPTE administered by the FSBPT.
• Jurisprudence Exam: Passing score on the North Dakota state law exam.
• Background Check: Submission to a statewide and nationwide criminal history record check.
• Continuing Education: Required CEUs must be completed and reported during the annual renewal cycle.

5. Medicaid Provider Enrollment

Providers must enroll through the North Dakota MMIS Web Portal by completing a multi-screen online application. Individual providers must affiliate with their billing group by entering the group's Medicaid ID or NPI on Screen 5 of the application.

During enrollment, providers must select the correct Provider Type, Specialty, and Taxonomy code. If the system prompts for a license but none is technically required for a specific sub-role, ND HHS instructs providers to enter 'DUM00000' as a placeholder, though licensed PTs must enter their actual NDBPT license number.

• Application Portal: North Dakota MMIS Web Portal (https://mmis.nd.gov/).
• Taxonomy Code: Must match the provider type and specialty selected during the MMIS application.
• Group Affiliation: Individual PTs must link to their group's Medicaid ID or NPI on Screen 5.
• Required Form: SFN 1168 must be completed, signed, and submitted with the application.
• Tax Documentation: A federal W-9 form matching the IRS legal name and EIN must be uploaded.

6. Staffing, Training and Background Checks

Physical therapy practices must ensure that all treating staff hold valid North Dakota licenses. Physical Therapist Assistants (PTAs) may provide treatments but must do so under the supervision of a licensed Physical Therapist, adhering to the supervision ratios and documentation co-signature rules set by the NDBPT.

All enrolled providers and managing employees are subject to federal exclusion database checks (LEIE/SAM) during the Medicaid enrollment process. Any adverse legal actions or sanctions must be disclosed on Screen 8 of the MMIS application and accompanied by supporting documentation.

• PTA Supervision: PTAs must be supervised by a licensed PT according to NDBPT administrative rules.
• Exclusion Checks: Staff must not be listed on the OIG LEIE or SAM.gov exclusion lists.
• Sanction Disclosure: Must answer Yes/No to sanction questions on Screen 8 and provide documentation if Yes.
• CPR Certification: Clinical staff are typically required to maintain basic life support (BLS) certification.
• Criminal History: Initial licensure requires a background check through the ND Bureau of Criminal Investigation.

7. Documentation, Policies and Records

ND Medicaid General Provider Policies dictate that providers must keep legible medical and financial records that fully justify and disclose the extent of services provided and billed. Documentation must clearly demonstrate medical necessity and link directly to the established plan of care.

Records must include the date of service, the specific modalities performed, the duration of the treatment, and the patient's response. Progress notes must be maintained to justify ongoing treatment, especially when approaching service limits that require prior authorization.

• Record Retention: Medical and financial records must be retained for a minimum of six years.
• Initial Evaluation: Must document baseline functional status, diagnosis, and measurable goals.
• Treatment Notes: Must include date, time in/out, specific interventions, and provider signature.
• Plan of Care Updates: Must be reviewed and updated by the PT at intervals dictated by patient progress.
• Audit Compliance: Records must be made available to ND HHS or its designees upon request.

8. Billing, Rates and Claims

Physical therapy claims are submitted using standard CPT codes (e.g., 97110 for therapeutic exercise, 97116 for gait training) via the 837P electronic transaction or the MMIS Web Portal. Providers must utilize the ND Medicaid Procedure Code Look-up Tool to verify current rates, age restrictions, and Service Authorization (SA) requirements.

ND Medicaid enforces a strict one-year timely filing policy; claims received more than one year from the date of service will be denied. Certain therapy services may have annual visit limits (e.g., 30 visits per year for adults), after which a Service Authorization is required for continued reimbursement.

• Timely Filing: Claims must be submitted and received within 1 year from the date of service.
• Procedure Code Look-up Tool: Used to identify covered codes, rates, and authorization rules (https://www.hhs.nd.gov/nd-medicaid-procedure-code-look).
• Service Authorization: Required for visits exceeding annual limits or for specific restricted codes.
• Electronic Billing: Claims should be submitted directly through the North Dakota MMIS Web Portal or via a clearinghouse.
• Retroactive Billing: Allowed up to 90 days prior to application receipt, provided the provider met all eligibility requirements on the date of service.

9. Approval Sequence and Timeline

The approval sequence begins with obtaining the NDBPT license, which can take several weeks depending on exam schedules and background check processing. Once licensed, the provider submits the Medicaid enrollment application via the MMIS Web Portal.

Noridian Healthcare Solutions processes the Medicaid applications on behalf of ND HHS. The Claim Submission Effective Date is established during this review; providers may request a retroactive effective date up to 90 days prior to the date the complete application packet was received by the state.

• Licensure Timeline: NDBPT processing varies but generally takes 2-4 weeks after all documents and exam scores are received.
• Medicaid Application: Submitted online via the ND MMIS Web Portal.
• Retroactive Limit: Maximum of 90 days prior to the receipt of a complete application packet.
• Effective Date: The Claim Submission Effective Date will not be changed after the application is approved.
• Web Access Registration: Completed after the application is approved to allow for direct claim submission.

10. Common Denials and Survey Findings

Medicaid enrollment applications are frequently delayed or denied due to mismatched information between the IRS, the NPI registry, and the MMIS application. A common error is failing to ensure the Legal Name and EIN on Screen 1 exactly match the provided W-9 form.

On the billing side, claims are commonly denied for exceeding the one-year timely filing limit or for failing to secure a Service Authorization once the annual visit threshold has been met. Missing group affiliation links on Screen 5 will also cause individual provider claims to reject.

• Name/EIN Mismatch: Legal name on the application does not perfectly match the IRS W-9.
• Missing Affiliation: Individual PT failed to link to the billing group's Medicaid ID or NPI.
• Timely Filing: Claims submitted more than 365 days after the date of service are automatically denied.
• Authorization Missing: Billing for visits beyond the annual limit without an approved Service Authorization.
• Incomplete Forms: Failure to include the Social Security Number and Date of Birth of the signee on SFN 1168.

11. Key Contacts and Resources

Providers seeking assistance with Medicaid enrollment should contact the ND Medicaid Provider Enrollment unit, managed by Noridian. The MMIS Web Portal provides access to manuals, the Procedure Code Look-up Tool, and electronic application status tracking.

For questions regarding professional scope of practice, continuing education, or state jurisprudence, providers must contact the North Dakota Board of Physical Therapy directly.

• ND Medicaid Provider Enrollment Phone: (877) 328-7098 (Monday to Friday 8 am - 5:00 pm CST).
• ND MMIS Web Portal: https://mmis.nd.gov/
• ND HHS Covered Services Manuals: https://www.hhs.nd.gov/healthcare/medicaid/provider/manuals-and-guidelines/covered-services
• North Dakota Board of Physical Therapy: https://www.ndbpt.org/
• Procedure Code Look-up Tool: https://www.hhs.nd.gov/nd-medicaid-procedure-code-look

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