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

Last reviewed: 2026-09-10

The Washington State Department of Health (DOH) Board of Physical Therapy licenses physical therapists under WAC 246-915, while the Washington State Health Care Authority (HCA) enrolls them into Apple Health (Medicaid) through the ProviderOne system.

Approval requires securing an active, unrestricted state license before submitting a Core Provider Agreement to HCA. Applicants must also secure credentialing and contracts with the five Apple Health Managed Care Organizations (MCOs) to serve the majority of Medicaid beneficiaries, as fee-for-service enrollment alone yields limited patient access.

1. Service Definition and Scope

In Washington, physical therapy is defined under RCW 18.74 as the care and services provided by or under the direction and supervision of a licensed physical therapist. This includes evaluating, diagnosing, and treating physical dysfunction through therapeutic exercise, manual therapy, and other interventions.

The service addresses mobility, strength, balance, and fall risk for Medicaid beneficiaries. It can be delivered in outpatient clinics, hospitals, or as a specialized service under Home and Community-Based Services (HCBS) waivers when state plan limits are exhausted.

• Statutory Definition: RCW 18.74.010 defines physical therapy as care provided by or under the direction of a licensed physical therapist.
• Scope of Practice: Includes evaluating, diagnosing, and treating physical dysfunction through therapeutic exercise and interventions.
• Supervision: Physical therapist assistants (PTAs) must practice under the supervision of a licensed PT.
• Assistive Personnel: Aides and other assistive personnel require direct on-site supervision by a PT or PTA.

2. Regulatory and Oversight Agencies

The Washington State Department of Health (DOH) regulates the clinical practice and licensure of physical therapists. The Board of Physical Therapy oversees rulemaking and disciplinary actions.

The Washington State Health Care Authority (HCA) administers the Apple Health (Medicaid) program, managing provider enrollment, fee schedules, and billing guidelines.

• Licensing Authority: Washington State Department of Health (DOH) Board of Physical Therapy (https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/physical-therapist)
• Medicaid Agency: Washington State Health Care Authority (HCA) (https://www.hca.wa.gov)
• Medicaid Portal: ProviderOne (https://www.waproviderone.org)
• Managed Care Oversight: HCA Apple Health Managed Care (https://www.hca.wa.gov/billers-providers-partners/programs-and-services/managed-care)

3. Gatekeeping Prerequisites: Who Can Even Apply

Washington does not restrict the establishment of outpatient physical therapy clinics through need-based planning. There are no Certificate of Need (CoN) requirements or Request for Proposal (RFP) procurements blocking entry for this service.

The primary structural precondition is obtaining the professional license. HCA maintains an open enrollment network for fee-for-service Apple Health, though providers must subsequently contract with MCOs to access most patients.

• Licensure Prerequisite: An active, unrestricted Washington DOH Physical Therapist license is strictly required before HCA will process a ProviderOne application.
• Certificate of Need: None exists; Washington does not subject outpatient physical therapy clinics to Certificate of Need (CoN) review.
• Network Access: Apple Health maintains an open network for fee-for-service enrollment, with no moratoria or closed enrollment windows.
• Managed Care Contracting: While HCA enrollment is open, serving most Apple Health clients requires subsequent credentialing and contracting with designated MCOs (e.g., Molina Healthcare of Washington, Community Health Plan of Washington).

4. Licensure and Certification Requirements

Physical therapists must meet strict educational and examination standards set by the DOH Board of Physical Therapy under WAC 246-915. Applicants must graduate from an accredited program and pass national and state-specific exams.

Licenses must be renewed annually, and practitioners must complete ongoing clinical and educational requirements to maintain active status.

• Education: Graduation from a Commission on Accreditation in Physical Therapy Education (CAPTE) accredited physical therapy program.
• Examination: Passing score on the National Physical Therapy Examination (NPTE).
• Jurisprudence: Passing score on the Washington State Physical Therapy Jurisprudence Exam.
• Continuing Education: 32 hours of continuing education every two years, plus 200 hours of clinical practice.

5. Medicaid Provider Enrollment

Providers must enroll with HCA through the ProviderOne system to bill for Apple Health services. Enrollment requires selecting the correct provider type (Individual, Group Practice, or Facility/Agency).

Institutional providers and group practices may be subject to federal application fees, while individual practitioners enrolling as solo providers are generally exempt.

• System: Applications must be submitted electronically through the ProviderOne portal.
• Agreement: Providers must sign the HCA Core Provider Agreement and Debarment Statement.
• Application Fee: Institutional providers (facilities/groups) must pay the CMS-mandated application fee ($730 for 2025, $750 for 2026); individual practitioners are generally exempt.
• NPI Requirement: Must register with a National Provider Identifier (NPI) matching the enrollment type (Type 1 for individuals, Type 2 for groups/facilities).

6. Staffing, Training and Background Checks

DOH mandates background checks and specific training for all licensed physical therapists in Washington. These requirements ensure patient safety and compliance with state health initiatives.

Supervision ratios are strictly enforced to ensure that assistive personnel do not operate beyond their scope of practice.

• Background Check: DOH requires a Washington State Patrol and FBI fingerprint-based background check during initial licensure.
• Suicide Prevention Training: PTs must complete a one-time, three-hour DOH-approved suicide assessment training.
• CPR Certification: Must maintain current CPR certification.
• Supervision Ratios: A physical therapist may supervise a maximum of three assistive personnel at any one time.

7. Documentation, Policies and Records

Clinical documentation must comply with both DOH regulations (WAC 246-915) and HCA's Outpatient Rehabilitation billing guidelines. Records must clearly demonstrate medical necessity and track patient progress.

Providers must maintain comprehensive policies regarding patient privacy, billing integrity, and record retention.

• Initial Evaluation: Must document a comprehensive initial evaluation, including objective findings and a plan of care.
• Progress Notes: Required for every visit, detailing the specific interventions provided and the patient's response.
• Discharge Summary: Must document the patient's status at discharge and progress toward goals.
• Record Retention: HCA requires Medicaid providers to retain all clinical and billing records for a minimum of six years.

8. Billing, Rates and Claims

Physical therapy services are billed using standard CPT codes through ProviderOne for fee-for-service clients, or through the respective MCO portals for managed care clients.

HCA publishes the Outpatient Rehabilitation Fee Schedule, which dictates the maximum allowable reimbursement for each procedure code.

• Fee Schedule: Rates are published in the HCA Outpatient Rehabilitation Fee Schedule.
• Prior Authorization: HCA requires prior authorization for PT services exceeding the annual unmanaged visit limits (typically 24 units for adults).
• Coding: Services are billed using standard physical medicine CPT codes (e.g., 97110 for therapeutic exercise, 97116 for gait training).
• Modifiers: Claims must include appropriate modifiers (e.g., GP to indicate services delivered under an outpatient physical therapy plan of care).

9. Approval Sequence and Timeline

The process begins with obtaining the DOH license, followed by HCA Medicaid enrollment, and concludes with MCO credentialing. Each step must be completed sequentially.

Providers should plan for a multi-month process before they are fully authorized to bill for all Apple Health clients.

• DOH Licensure: Processing typically takes 4 to 6 weeks after all documents and background checks are received.
• ProviderOne Submission: HCA strives to process complete Medicaid enrollment applications within 30 days of receipt.
• MCO Credentialing: Subsequent credentialing with Apple Health MCOs can take an additional 60 to 90 days.
• Total Timeline: New providers should expect a 3 to 5 month end-to-end process before they can bill for managed care clients.

10. Common Denials and Survey Findings

Enrollment applications are frequently delayed due to administrative errors, while clinical claims are often denied for failing to meet HCA's strict authorization rules.

Post-payment audits by HCA or MCOs frequently target missing documentation or services billed beyond the authorized limits.

• Incomplete Applications: ProviderOne applications are frequently delayed due to missing signatures on the Core Provider Agreement or W-9.
• Background Check Delays: DOH licensure delays often stem from rejected fingerprint cards or out-of-state background check processing times.
• Documentation Deficiencies: Post-payment audits frequently cite missing or incomplete plans of care signed by the referring provider.
• Authorization Failures: Claims are commonly denied for exceeding the unmanaged visit limit without securing prior authorization from HCA or the MCO.

11. Key Contacts and Resources

Providers must utilize official state portals for licensure, enrollment, and billing guidance. The DOH and HCA websites provide the authoritative manuals and fee schedules.

Support for the ProviderOne system is available through the HCA support portal.

• DOH Board of Physical Therapy: https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/physical-therapist
• HCA Provider Enrollment: https://www.hca.wa.gov/billers-providers-partners/become-apple-health-provider/enroll-provider
• ProviderOne Portal: https://www.waproviderone.org
• HCA Outpatient Rehabilitation Billing Guide: https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/provider-billing-guides-and-fee-schedules

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