PECOS Medicare Enrollment for PT OT SLP (Uploads)

Mobile Therapists – PECOS Medicare Enrollment Required Documents

If you are a physical therapist, occupational therapist, or speech language pathologist AND you are only treating patients in their homes, you will need to upload the following three documents to complete your PECOS Medicare enrollment:

1. CP 575 IRS Letter
2. Voided Business Check or Letter from your Bank
3. CMS 460 MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT

CP 575 Letter from the IRS

This is the letter you would have recieved from the IRS when you applied for your tax identificiation number.

Your Tax ID is the same as your tax identification number (TIN), which is also the same as your employer identification number (EIN).

For reference, look at the image below.

• Be sure to note that if your business name contains the letters LLC, PC, PLLC or any other designation, then your business check and NPI listing must match exactly.
• Commas may be ignored before the first L of LLC.
• Note that if you are the only owner of an LLC you should be a Sole MBR.

* How to apply for a Tax Identification Number

Voided Business Check

Most new businesses will recieve “starter checks” upon opening a business bank account.

A starter check is not acceptable when applying for PECOS Medicare enrollment.

You will either need an actual business check as shown in the image below, or a letter from your business bank account.

Take note that the business name at the top left of your check must exactly match your business name on the CP 575 letter.

If your CP 575 letter shows LLC then your business check must have an LLC.

Bank Letter

If you do not have business checks and do not plan to purchase them, you may secure a letter from your bank.

Below is a sample of the bank letter along with a list of exactly what is required on the letter.

If you do not have a check and choose to upload a bank letter, the PECOS Medicare enrollment will require the following 6 items:

1. Group’s name as it apprears on CP 575
2. Account Number
3. Routing Number
4. Account Type (Checking or Savings)
5. Must be signed by a bank official (Signature and Printed Name)
6. Must be on bank letterhead

CMS 460

The final document required for PECOS Medicare enrollment upload is a copy of the CMS 460 Medicare Participating Physician or Supplier Agreement.

How to complete the CMS 460

In the sample CMS 460 document below you can see:

1. The top left section contains the business name as it appears on the CP 575 and the business address.
2. The top right section contains the business NPI.
3. The middle section under item #2 contains the date you wish to see your first Medicare beneficiary. This date may be up to 30 days before your application submission.
4. The bottom will contain your signature, the date you signed, your title in the business, and the business phone number.