Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy (OPT) and/or Speech Pathology Services (OSP)- Initial and Extension Site Requests (CMS-381)

Medicare approved providers of Outpatient Physical Therapy and Speech Pathology Services (OPT) may provide services at additional locations in addition to their Medicare approved primary site. These additional locations are called “extension locations” and must be reported by the provider and approved by CMS. Form CMS-381 provides a method for OPT providers to meet this reporting requirement.

The latest form for Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy (OPT) and/or Speech Pathology Services (OSP)- Initial and Extension Site Requests (CMS-381) expires 2021-01-31 and can be found here.