Physical Therapy Direct Access Laws by State

This month’s blog posts are all about direct access. Fifty states—plus Washington, DC and the US Virgin Islands—allow some form of physical therapy without a physician referral. However, the regulations vary from state to state. So, I’m going to break it all down—from AL to WY—in the next four blog posts.

Before we dive into the regulations for every state, I want to mention that I am not a legal expert, and I’ve sourced all of the following information from the APTA and various state association websites. If you have any questions about your state’s law, please consult your state’s practice act, a PT compliance expert, or your attorney. With that, let’s talk direct access from sea to shining sea:

States organized alphabetically

Alabama

A physical therapist can treat direct access patients when:

• The patient is a child diagnosed with a developmental disability. Therapy must be in accordance with the child’s plan of care.
• Physical therapy is in accordance with the plan of care for a patient seen in a home health agency setting.
• The patient is in a nursing home and physical therapy is in accordance with the plan of care.
• The patient receives preventative treatment in a wellness setting to prevent injury, provide conditioning, promote fitness, or reduce stress.
• The patient has received a diagnosis within the last 90 days and physical therapy is seen as appropriate for treating the diagnosed condition. The therapist has to let the patient’s physician know within 15 days of starting physical therapy and provide the physician with a plan of care for the treatment episode.

Alaska

There are no restrictions to direct access in Alaska. However, a physical therapist’s license could be suspended or revoked if the therapist doesn’t refer a patient out of his or her clinic when the scope of care is outside of the therapist’s expertise.

Arizona

There are no restrictions to direct access in Arizona. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to the appropriate healthcare provider.

Arkansas

When a patient is receiving treatment for bronchopulmonary hygiene, debridement, or wound care, a physician referral is required. There are no other restrictions in this state.

California

A physical therapist can treat direct access patients when:

• The therapist believes the care falls within the scope of physical therapy. If the therapist thinks the care is outside of his or her scope, or if the patient is not improving or meeting his or her goals, the therapist must refer out to an appropriate healthcare provider.
• The therapist has told the patient if he or she has any financial interest in treating the patient. If the therapist is working for a physical therapy corporation, he or she must comply with Chapter1, Article 6, commencing with Section 650.
• After receiving written patient consent, the therapist has notified the patient’s doctor (or surgeon) that the patient is receiving physical therapy care.
• Therapy does not extend beyond 45 calendar days or 12 visits—whichever comes first—without a signed and dated plan of care. The approved plan of care can come from the patient’s physician, surgeon, or podiatrist. Additionally, the patient’s physician, surgeon, or podiatrist must have examined the patient in person and performed any necessary tests.
• The patient has been given both written and verbal notice that the therapist can provide treatment for up to 45 calendar days or 12 visits—whichever comes first. The written notice must be in at least 14-point font and signed by the patient. The physical therapist also must notify the patient that physical therapy can be continued (after the aforementioned time frame) only after the patient’s physician, podiatrist, or surgeon has signed a plan of care and has performed an in-person exam of the patient.

Colorado

A physical therapist can treat direct access patients when:

• Therapy is within the therapist’s scope of expertise. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider. If the therapist does not refer out when appropriate, he or she will receive disciplinary action.

Connecticut

A physical therapist can treat direct access patients when:

• The therapist has at least a master’s degree; or, if the therapist has a bachelor’s degree, he or she has practiced physical therapy for at least three of the last six years.
• The patient shows improvement after six visits or 30 consecutive days—whichever comes first. Following this time period, if upon evaluation (or re-evaluation), the patient’s functional level has not improved both objectively and measurably, then the therapist must refer the patient to a primary care provider.
• The patient has disclosed or confirmed the name of his or her primary care provider (or past provider) the first time he or she is seen for physical therapy.
• “Physical therapy” does not include surgery; prescribing drugs; or diagnosing disease, injury, or illness.”

According to the OLR Bill Analysis, sSB 164, there are three instances when a verbal or written referral is required before a patient can receive physical therapy in Connecticut:

1. When the therapist knows the condition being treated is connected to a job-related injury.
2. “If the therapist does not meet the standards mentioned above for direct access.”
3. “The therapist is required to perform a Grade V spinal manipulation without a PhD in physical therapy (from an accredited university) or without proof that he or she has completed 25 hours of coursework in Grade V spinal manipulation that meets the Physical Therapy Board of Examiners’ minimum standards, and three years of experience in such treatment.”

Regarding work-related injuries, the OLR Bill Analysis, sSB 164 states the following: “A physical therapist does not violate the requirement for a referral to treat work-related injuries if he [or she] asks the patient about the source and nature of his [or her] condition and the patient does not disclose that it ‘arose out of and in the course of the patient’s employment.’ This term encompasses an accidental injury or occupational disease that started while the patient was working at the employer’s work site or elsewhere at the employer’s direction. For a police officer, firefighter, and certain Department of Correction employees, it includes travel to and from home and work.”

DC

A physical therapist can treat direct access patients when the patient has made progress within 30 days of starting therapy. If no progress has been made within 30 days of starting therapy, the patient must be referred to a primary care provider.

Delaware

A physical therapist can treat direct access patients when:

• Therapy is within the therapist’s scope of expertise. If a therapist thinks the care falls outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
• Treatment is provided for up to 30 days; after that, a physician must be “consulted.”
• The patient’s prescriptions are not altered or modified by the therapist.

Florida

A physical therapist can treat direct access patients when:

• Therapy is within the therapist’s scope of expertise. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
• A practitioner on record (meaning the practitioner has a license in the state of Florida) has previously seen the patient. If this has not occurred, then the PT must get a signed plan of care after 21 days.
• The patient is not being treated in an acute care setting. PTs are not allowed to treat direct access patients who are currently being treated in acute care settings, which include hospitals, ambulatory facilities, surgical centers, and mobile surgical facilities.
• The PT is not providing chiropractic care, including specific spinal manipulation. The therapist should refer out of the clinic if chiropractic care is necessary.

Georgia

A physical therapist can treat direct access patients when:

• Physical therapy is used preventatively in a wellness setting to prevent injury, provide conditioning, promote fitness, or reduce stress.
• A patient was already diagnosed by a physician and has received physical therapy for that same diagnosis within the past 60 days. If this happens, the therapist has to notify the referral source within five business days of the patient coming back for therapy.
• The PT has a master’s or doctorate degree, or has at least two years of experience as a licensed PT.
• The patient is improving within 90 days of the first visit. If the patient is not improving, the physical therapist must refer the patient to an appropriately licensed healthcare provider.

Hawaii

There are no restrictions to access in this state. However, if a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.

Idaho

There are no restrictions to access in this state. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider. Also, the therapist can’t use radiology, perform surgery, or diagnose a medical disease.

Illinois

A physical therapist can treat direct access patients when:

• The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider (e.g., a physician, dentist, or podiatrist).
• The therapist is only performing an initial evaluation. A referral is necessary for continued treatment.
• The PT has notified the patient’s physician, dentist, or podiatrist when the PT provides care in accordance with the diagnosis the healthcare provider gave.

Indiana

A physical therapist can treat direct access patients when:

• The treatment does not continue for more than 24 calendar days, beginning with the initial evaluation. The PT must then get a referral from the patient’s primary healthcare provider (e.g., physician, podiatrist, psychologist, chiropractor, dentist, nurse practitioner, or physician assistant).
• Spinal manipulation is not performed, unless the therapist has an order or referral from a physician, osteopath, or chiropractor.
• The PT does not remove any foreign material from a wound using sharp medical instruments. An order or referral is required from a physician, osteopath, or podiatrist for “sharp debridement.”

Iowa

A physical therapist can treat direct access patients when he or she does not perform osteopathic, chiropractic manipulation, or surgery. That being said, a hospital may require a member of the hospital medical staff to review the patient’s case before that patient receives in-hospital therapy. Additionally, physical therapists can not prescribe or administer drugs or medicine to patients.

Kansas

A physical therapist can treat direct access patients when:

• The patient is progressing toward reaching his or her goals in a measurable way. If he or she is not progressing within 10 visits or 15 business days from the initial evaluation, the PT must get a referral from an appropriately licensed healthcare provider.
• The therapist has given the patient notice that the therapy diagnosis is not a physician’s medical diagnosis.
• A licensed healthcare provider has approved wound debridement.
• A patient is not being treated in a hospital or ambulatory surgery center. If the patient is being treated in a hospital or ambulatory surgery center, the facility might require an order or referral.
• Treatment is for employees to educate them on how to avoid workplace injury, or the public is being treated in a wellness setting to prevent injury, provide conditioning, promote fitness, or reduce stress.
• A patient has an IEP (individualized education plan) or IFSP (individualized family service plan) and therapy can help fulfil the needs outlined by the IEP or IFSP.

Kentucky

There are no restrictions to direct access in Kentucky. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to a physician or dentist. When a patient is directly referred, the PT can discuss the patient’s case with the referring provider.

Louisiana

A physical therapist can treat direct access patients when:

• The patient is a child diagnosed with a developmental disability. Therapy must be in accordance with the child’s plan of care.
• Physical therapy is in accordance with the plan of care for a patient seen in a home health agency setting.
• The patient is in a nursing home and physical therapy is in accordance with the plan of care.
• Physical therapy is used preventatively in a wellness setting to prevent injury, provide conditioning, promote fitness, or reduce stress.
• Therapy is appropriate treatment for a condition diagnosed within the last 90 days. Within the first 15 days of therapy, the therapist also has to notify the physician who gave the diagnosis.

Maine

A physical therapist can treat direct access patients when:

• The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
• The therapist is not making a medical diagnosis.
• The patient is showing improvement within the first 30 days of treatment. Otherwise, the therapist must refer the patient to a licensed physician, osteopath, podiatrist, dentist, or chiropractor.
• Treatment does not continue for more than 120 days. After 120 days the patient must be referred to a licensed physician, osteopath, podiatrist, dentist, or chiropractor.

Some things to note:

1. A PT cannot conduct spinal manipulation or administer drugs.
2. If the patient is not referred, his or her employer is not responsible under workers’ compensation for services.

Maryland

A physical therapist is free to treat patients without restriction in this state.

Massachusetts

If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider. The PT must tell the patient if he or she has any financial interest in treating the patient.

Michigan

A physical therapist can treat direct access patients when:

• Treatment does not extend beyond 21 days or 10 visits. At that point, the physical therapist has to get a referral.
• Physical therapy is used preventatively in a wellness setting to prevent injury, provide conditioning, or promote fitness.

This law officially goes into effect January 1, 2015.

Minnesota

A physical therapist can treat direct access patients when:

• Therapy does not continue beyond 90 days without a referral.
• A therapist who has more than one year of experience supervises any therapists licensed for less than one year.
• The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
• Physical therapy is used preventatively in a wellness setting to prevent injury, provide education or conditioning, or promote fitness.

Mississippi

A physical therapist can treat direct access patients when:

• The patient is a child who has a diagnosed developmental disability. Physical therapy must follow the plan of care.
• Physical therapy is in accordance with the plan of care for a patient seen in a home health agency setting.
• The patient is in a nursing home and physical therapy follows the plan of care.
• Physical therapy is used preventatively in a wellness setting to prevent injury, provide education or conditioning, or promote fitness.
• Therapy is appropriate treatment for a condition diagnosed within the last 180 days. Within the first 15 days of therapy, the therapist also has to provide the patient’s plan of care to the physician who gave the diagnosis.

Missouri

A physical therapist can treat direct access patients when:

• The patient shows no symptoms of having a disorder and therapy is used preventatively in a wellness setting to prevent injury, screen or consult, provide education or conditioning, or promote fitness.
• Within the last year, a patient receives a diagnosis for a previously diagnosed chronic illness or an injury that could resolve itself without therapy. In this situation, the following rules apply:
  • Within seven days of starting therapy, the therapist must inform the patient’s current approved healthcare provider that he or she is treating the patient.
  • The therapist must get approval from the provider if the therapist plans to change an available pre-existing physical therapy referral.
  • If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
  • The patient must be progressing toward reaching his or her goals in a measurable way. If he or she is not progressing within six visits or 14 days (whichever comes first) from the initial evaluation, the PT must get a referral from an appropriately licensed healthcare provider.
  • The patient’s current approved healthcare provider has to be notified if the patient continues therapy after 30 days. The PT also has to notify the patient’s approved healthcare provider for each consecutive 30-day period.

  Montana

  If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider; otherwise, the therapist’s license will be revoked. The therapist also must be licensed. There are no other access restrictions in this state.

  Nebraska

  There are no restrictions to access in Nebraska. However, it is seen as unprofessional conduct if a therapist thinks the care is outside of his or her scope, but he or she does not refer the patient to an appropriate healthcare provider.

  Nevada

  There are no restrictions to access in Nevada. However, physical therapists in Nevada are not allowed to diagnose disabilities, work as massage therapists, or perform chiropractic adjustments.

  New Hampshire

  A physical therapist can treat direct access patients when:

  • The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
  • Physical therapy is believed to be appropriate treatment for the patient’s condition.
  • The patient shows documented improvement within the first 25 days of treatment.

  New Jersey

  A physical therapist can treat direct access patients when:

  • The patient is making reasonable progress toward his or her goals within 30 days of treatment. If the patient is not making progress within 30 days, the therapist must refer to an appropriate healthcare provider.
  • The therapist consults with the patient’s primary care physician within the first 30 days of care if the therapist is treating for functional limitation or for pain. If the patient does not have a primary care physician, the therapist must recommend that the patient consult with one.

  The therapist is not allowed to diagnose disease, practice medicine, or perform surgery. He or she is also barred from practicing podiatry, chiropractic care, occupational therapy, dentistry, or prosthetics.

  If the patient is seeking reimbursement from an auto insurance policy, he or she must have a referral from a licensed physician, dentist, podiatrist, or chiropractor.

  New Mexico

  A physical therapist can treat direct access patients when:

  • The patient has an existing diagnosis from a licensed primary care provider and that’s the reason the patient is seeking therapy.
  • The patient is in a special education program or in acute care (as long as the care is within the PT’s scope of practice).
  • The therapist notifies the patient’s primary care provider of the physical therapy diagnosis and plan of care every 60 days.

  New York

  A physical therapist can treat direct access patients when:

  • A licensed physical therapist performs treatment for no more than 10 visits or 30 days (whichever comes first).
  • The licensed physical therapist has three years—or more—of experience and is at least 21 years old.
  • At the beginning of treatment, the therapist provided the patient with a written notice that the patient’s health plan or insurer might not cover the services without referral. Per the APTA, the clinic has to keep a copy of this written notice in the patient’s file.
    • According to NYSED.gov (linked to from the NYPTA), in addition to everything above, the following applies: The notice must be given at the beginning of treatment and must contain:
      1. the start date of treatment;
      2. patient validation that he or she has read the notice;
      3. the patient’s signature and date of signature;
      4. the address and name of the patient; and
      5. the treating therapist’s signature, date of signature, name, and address.

    North Carolina

    A physical therapist can treat direct access patients when:

    • The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
    • The PT does not diagnose a disease.
    • The therapist does not perform manipulation of the spine. The therapist must have a prescription in this case.

    North Dakota

    If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider. Otherwise, the therapist’s license will be revoked. There are no other restrictions to access in this state.

    Ohio

    A physical therapist can treat direct access patients when:

    • The therapist has at least two years of experience or a master’s degree.
    • The patient is progressing towards his or her goals within the first 30 days of treatment. If the patient is not progressing within that time frame, the therapist must refer the patient to an appropriate healthcare provider.
    • Within five days of the initial evaluation, the therapist notifies the patient’s doctor of the evaluation.
    • The therapist only applies certain orthotic devices.

    Ohio Physical Therapy Association has a great page containing facts—and even a video—about direct access.

    Oklahoma

    According to HB1020, a physical therapist can treat direct access patients when:

    • Evaluation and treatment do not extend beyond 30 days. If therapy is to continue beyond 30 days, then the therapist must refer to an appropriate healthcare provider.
    • The patient is not being seen for a workers’ compensation claim.
    • The patient is a child and therapy is in accordance with the most recent versions of the Individuals with Disabilities Education Improvement Act of 2004 and the Rehabilitation Act of 1973, Section 504.
    • The patient is showing no symptoms of having a disorder and therapy is used preventatively in a wellness setting to prevent injury, screen or consult, provide education or conditioning, or promote fitness.

    This law officially goes into effect on November 1, 2014.

    Oregon

    If a therapist thinks the care is outside of his or her scope or that therapy is not appropriate, or if the therapist is unsure of how to treat the condition, then he or she must refer the patient to an appropriate healthcare provider. There are no other restrictions in this state.

    Pennsylvania

    A physical therapist can treat direct access patients when:

    • The licensed therapist has a certificate of authorization from the board.
      • This certificate authorizes treatment of only neurological, muscular, or skeletal conditions. The therapist must either consult with the patient’s healthcare provider about the treatment plan and condition of the patient (if the patient has an acute cardiac or an acute pulmonary condition), or refer out to obtain a diagnosis and referral.

      Rhode Island

      A physical therapist can treat direct access patients when:

      • The therapist receives written consent for treatment from the patient after the therapist has disclosed the scope and nature of physical therapy.
      • Treatment does not continue beyond 90 days. After 90 days, the therapist must obtain a referral from a physician, osteopath, dentist, podiatrist, or chiropractor.
      • The therapist has at least one year of clinical experience.

      South Carolina

      A physical therapist can treat direct access patients when:

      • Therapy does not continue beyond 30 days after the initial evaluation. If care continues beyond 30 days, the therapist must refer to a licensed physician or dentist.
      • The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to a licensed physician or dentist.

      South Dakota

      There are no restrictions to access in South Dakota.

      Tennessee

      According to Senate Bill 1144 physical therapists can treat direct access patients when:

      • Only an initial evaluation is performed.
      • The physical therapist’s goal is to assess and educate an asymptomatic person, including offering exercise recommendations.
      • There is no alternative medical attention available (i.e., the situation is an emergency—including minor emergencies—threatening the patient’s health). Such situations include:
        • Intense pain
        • A serious organ or body part disfunction
        • Serious deterioration of bodily functions with sudden onset of a medical condition
        1. With patient consent, the physical therapist notifies the patient’s physician, chiropractor, dentist, podiatrist, or osteopath no later than five days after initial evaluation. If the patient hasn’t been seen by a licensed physician, chiropractor, dentist, podiatrist, or osteopath within the last year, then the patient does not have to consent in order for the therapist to contact the appropriate healthcare provider. If the patient has not been seen by a licensed healthcare provider, then the therapist has to provide a list of available providers and make the patient aware of the 45-day limitation to treatment.
        2. If within the first 15 calendar days or six visits (whichever comes first), the patient is not making substantial progress, the therapist must refer the patient to a licensed physician, chiropractor, dentist, podiatrist, or osteopath.
        3. If the patient has been diagnosed with a recurring condition (neuromuscular or developmental) and is showing symptoms associated with the previously diagnosed condition, both of the above provisions (a and b) do not apply. If within 90 days, the patient returns to therapy for treatment of the same condition, then the physical therapist must immediately refer the patient to an appropriate healthcare provider.
        4. If the patient’s physician, chiropractor, dentist, podiatrist, or osteopath has not been notified of the treatment, therapy can’t continue for more than 45 days after the patient’s first visit.
        5. It’s considered unprofessional conduct when the therapist knowingly starts treatment for a patient:
           • Who has reached the 15-day and six-visit limit, and no progress has been made from being treated by another therapist; or
           • Who has reached the aforementioned 45-day time limit.
        6. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider.
           • In order to treat direct access patients, the therapist must be licensed and in good standing and CPR certified (or in possession of an equivalent certification) unless one of the following is true:
             • The therapist has at least one year of experience as a licensed physical therapist and at least a master’s degree from an accredited professional physical therapy program. The board of occupational and physical therapy examiners must recognize the agency accrediting the program.
             • The therapist has completed a board-approved clinical fellowship or residency.
             • The therapist has at least three years of experience as a licensed physical therapist; and
               • he or she has successfully completed a board-approved course that lasts at least 18 hours and teaches the therapist how to recognize symptoms of systemic disease—more specifically, symptoms that mimic cardiological, neurological, oncoligical, or musculoskeletal disorders. The class must also teach the therapist how to recognize when and in what time frame to refer to a physician, dentist, osteopath, chiropractor, or podiatrist.

        Texas

        A physical therapist can treat direct access patients when:

        • The therapist does not diagnose a disease.
        • Physical therapy is used preventatively in a wellness setting to prevent injury, provide conditioning, promote fitness, or reduce stress.
        • There is no alternative medical attention available (i.e., the situation is an emergency threatening the patient’s health). Such situations include:
          • A serious organ or body part disfunction, or
          • Serious deterioration of bodily functions with a sudden onset of a medical condition.
          • At the start of therapy, the therapist notifies the original referring physician by letter postmarked within five business days, or by phone within five days.
          • Treatment must not continue beyond 30 calendar days or 20 treatment sessions (whichever comes first). At the end of 30 days or 20 treatment sessions, the therapist has to speak with the referring provider before continuing with therapy.
          • The original referral to physical therapy is not more than one year old.
          • The therapist has been licensed for at least one year. He or she can work with another therapist with less than one year of experience or a physical therapist assistant, as long as the licensed therapist of more than one year remains responsible for supervision of the treatment.

          Utah

          There are no restrictions to access in this state. However, a physical therapist is not allowed to diagnose disease, use an X-ray for therapy or for diagnosis, or perform surgery.

          Vermont

          There are no restrictions to access in this state.

          Virgin Islands

          As of October 9, 2014, therapists are allowed to treat direct access patients when treatment does not extend beyond 45 days or 12 treatment visits (whichever comes first).

          Virginia

          A physical therapist can treat direct access patients when:

          • The therapist has a certificate of authorization in accordance with Section 54.1-3482.
          • Treatment does not extend beyond 14 consecutive business days from the date of initial evaluation and:
            • The patient attests he or she is not currently being seen by a physician, chiropractor, or other provider for the same problem therapy is addressing.
            • The patient can give the therapist the name of a licensed healthcare provider the patient plans to see if his or her condition does not improve within the 14-day time frame. The therapist must receive this information before the start of evaluation and treatment.
            • The patient must provide written consent that the therapist can release all PHI and records to the above-mentioned healthcare provider.
            • The physical therapist must give the above-mentioned provider a copy of the initial evaluation, along with a copy of the patient’s history, within the first three days of treatment.
            • The therapist must contact the abovementioned healthcare provider at the end of the 14-day period to see if he or she will authorize any further physical therapy treatment until the patient is able to see the provider.
            • The patient must not have been evaluated for the same injury within the last three months in order for the therapist to perform an initial evaluation.

            There are no restrictions to direct access treatment of students, athletes in a school setting, or students with an IEP (individualized education plan). There also are no restrictions regarding physical therapy used preventatively in a wellness setting to prevent injury, provide conditioning, promote fitness, or reduce stress.

            Washington

            A physical therapist can treat direct access patients when:

            • The therapist does not use orthotics in treatment.
            • The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to a licensed physician or dentist.

            Payers can implement restrictions to reimbursement for physical therapy services at their own discretion.

            West Virginia

            There are no restrictions to access in this state. However, electromyography exams and electrodiagnostic studies are prohibited unless the therapist uses them to determine chronaxie and strength duration curves. However, a physician electromyographer and electrodiagnostician must supervise.

            Wisconsin

            Per the APTA, A physical therapist can treat direct access patients when:

            • The therapist is practicing in a school setting and treating children with “exceptional” education needs.
            • The patient is in a nursing home and physical therapy follows the plan of care.
            • The therapist is part of a home health agency.
            • Physical therapy is used preventatively in a wellness setting to prevent injury, provide conditioning, promote fitness, or reduce stress. The exception would be treatment for acute fractures or soft tissue injuries.
            • A patient has been previously diagnosed with a condition, and the therapist has notified the healthcare provider who made the diagnosis.

            Wyoming

            A physical therapist can treat direct access patients when:

            • The therapist has at least five years of experience and a bachelor’s degree.
            • The patient has been diagnosed with a recurring injury within the last year.
            • The patient is a child and is under an IEP (individualized education plan) or an IFSP (individualized family service plan). Otherwise, a child under the age of 12 is not allowed to be treated without a prescription unless it is an emergency situation.

            If a therapist thinks the care is outside of his or her scope or that therapy is not appropriate, or if a patient has been treated without prescription for 12 visits or for 30 days (whichever comes first), or if the therapist is unsure of how to treat the condition, then the therapist must refer the patient to an appropriate healthcare provider. This is true for most patients except those participating in therapist-run exercise or fitness programs, or those patients with an IEP or IFSP.

            And there you have it. Summed up, some form of direct access in all 50 states, plus DC and the US Virgin Islands. Wowza, I’m exhausted. How about you? Time for a little R&R.