Therapist Enrollment Updates Effective 03/05/2024
Virginia Department of Medical Assistance Services (DMAS) will be implementing changes to the enrollment for Individual therapists. These changes will accommodate the correct enrollment guidelines for Physical Therapist (PT), Occupational Therapist (OT), and Speech Therapist (SP). Therapists, except for Ordering, Prescribing, and Referring (OPR) enrollment types, must be enrolled as MCO Only.
DMAS has designated the following Provider Types (PT) and specialties for Therapist enrollments.
- PT 039 – Therapist-OPR Only
- Enrollment Type – Ordering, Prescribing, and Referring (ORP)
Specialty Description | Enrollment Type-Allowed | |
043 | Speech-Language Pathologist | OPR |
045 | Occupational Therapist | OPR |
154 | Physical Therapist | OPR |
- PT 339 – Therapist-MCO Only
- Enrollment Type – Individual (I), and/or Individual w/in a Group (IG)
Provider Specialty | Specialty Description | Enrollment Type-Allowed |
043 | Speech-Language Pathologist | I, IG (MCO Only) |
045 | Occupational Therapist | I, IG (MCO Only) |
145 | Occupational Therapy | I, IG (MCO Only) |
154 | Physical Therapist | I, IG (MCO Only) |
239 | Respiratory, Developmental, Rehabilitative, Physical Therapy, Rehabilitation, and Speech and Language Therapy
| I, IG (MCO Only) |
254 | Physical Therapy | I, IG (MCO Only) |
339 | Rehabilitation | I, IG (MCO Only) |
343 | Speech and Language Therapy | I, IG (MCO Only) |
To facilitate this change maintenance will be performed to update your current PT 039 enrollments.
These changes will occur internally; providers are not required to take any action. Therapy providers may receive termination and enrollment notifications as these enrollment updates will result in some current provider service locations being termed, and/or re-added with a new SL for the correct provider type. These notifications will provide details on the service locations that were terminated, and subsequent new service locations added, if applicable.
Enrollment Updates to Current PT 039 Service Locations (SL)
- Current PT 039 - enrolled as an I or IG
- VA FFS Only
- PT 039 SL will be termed.
- VA FFS and MCO
- PT 039 SL will be termed.
- Provider record will be re-added with a new SL ID as a PT 339 with MCO Participation Only (VA FFS contract will not be included under new service location).
- MCO Only
- PT 039 SL will be termed.
- Provider record will be re-added with a new SL ID as a PT 339 with MCO Participation Only.
- VA FFS Only
- Current PT 039 enrolled as an OPR and PS is not 043 (ST), 045 (OT), and 154 (PT)
- VA FFS Only
- PT 039 SL will be termed.
- VA FFS and MCO
- PT 039 SL will be termed.
- Provider record will be re-added with a new SL ID as a PT 339 with MCO Participation Only (VA FFS contract will not be included under new service location).
- MCO Only
- PT 039 SL will be termed.
- Provider record will be re-added with a new SL ID as a PT 339 with MCO Participation Only.
- VA FFS Only
- Current PT 039 enrolled as an OPR and is 043 (ST), 045 (OT), and 154 (PT)
- VA FFS Only
- PT 039 SL will not be termed.
- VA FFS and MCO
- PT 039 SL will not be termed.
- MCO Only
- PT 039 SL will not be termed.
- VA FFS Only
If you have additional questions regarding the changes to enrollment for therapists, please contact the Provider Enrollment Help Desk at 1-888-829-5373.