National Provider Identifies (NPI) Required

National Provider Identifier (NPI) Registered with Texas Medicaid

Medicaid has required providers to obtain a referral for speech and audiology services, and a prescription for occupational and physical therapy services. Beginning November 1, 2022, all referring and prescribing providers for these services must obtain a National Provider Identifier (NPI) number and must be enrolled in Medicaid as individual practitioners.

Occupational and physical therapists are not required to get a NPI. The prescription is completed by a  physician, Physician’s Assistant (PA), or Advanced Practice Registered Nurse (APRN) with a NPI that is registered with Texas Medicaid.

The speech and audiology referral can be completed by a Texas licensed speech pathologist (who is eligible to provide service independently without supervision), audiologist, or by a physician, Physician’s Assistant (PA), or Advanced Practice Registered Nurse (APRN). The referrer must have a NPI that is registered with Texas Medicaid.

For the purposes of SHARS, speech therapists may only make speech referrals and audiologists may only make audiology referrals.

Speech therapists and audiologists may not make referrals of any kind outside of SHARS.

For dates of service on or after November 1, 2022, LEAs must include the referring or prescribing provider NPI number on interim claims submitted to TMHP for SHARS occupational therapy, physical therapy, speech therapy, and audiology services. Beginning November 1, 2022, interim claims will be rejected if the NPI of the Texas Medicaid-enrolled referring or prescribing provider is not on the claim.

National Provider Identifier (NPI) Security

The NPI is a unique identification number for covered health care providers. The numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. Your NPI is publicly available on the National Plan and Provider Enumeration System. Providers do not have an option to op-out of this data dissemination system. Providers are encouraged to safeguard their NPI numbers. Current information should be maintained in the NPI system.  Also, practitioners should be aware of their NPI usage.