Direct Access Laws by State (Rhode Island-Wyoming)

Well folks, it’s been a heck of a journey, but we’ve finally made it to the last leg. In the final installment of this four-part series, we’ll be hitting up New England and making our way cross-country to the Cowboy State. (Previously, I covered Alabama – Hawaii, Idaho – Mississippi, and Missouri – Pennsylvania.) But before we get down to business, I’d be remiss if I didn’t mention that I’m by no means a legal expert, and all of the following info was sourced from this APTA document. So, before you accept any direct access patients in your practice, be sure to consult with an attorney or PT compliance expert. With that out of the way, let’s get to it:

Rhode Island

• Rhode Island is one of 26 states that allow direct patient access to PT with some provisions.
• Treatment may be administered with the following provisions:
  • The PT must provide a written disclosure to the patient indicating the scope and limitations of physical therapy, and the therapist shall obtain the patient’s written consent to therapy.  
  • The PT must refer the patient to an appropriate healthcare provider within 90 days of the first treatment day.  
  • Any PT who accepts direct access patients must have at least one year of clinical experience.

South Carolina

• South Carolina is one of 26 states that allow direct patient access to PT with some provisions.
• Treatment may be administered with the following provisions:
  • If there is no physician referral and the PT treats the patient beyond 30 days from the initial evaluation, the PT must refer the patient to an appropriate healthcare provider.  
  • The PT must refer the patient to an appropriate healthcare professional if the PT feels that the patient’s care goes beyond the physical therapy scope of practice.

South Dakota

• South Dakota is one of 18 states that allow patients total, unrestricted access to a physical therapist. According to state law, no type of physician referral is required for a physical therapist to evaluate or treat a patient, and there are no provisions to treatment.

Tennessee

• Tennessee is one of 26 states that allow direct patient access to PT with some provisions.
• Treatment may be administered with the following provisions:
  • With the patient’s consent, the PT must inform the patient’s healthcare provider of the physical therapy care plan no later than five business days after the PT evaluation.
    • If the patient seeks physical therapy for a problem that has already been addressed by his or her physician within the past 12 months, the PT does not need patient consent to inform the physician.
  • If the patient doesn’t have a primary physician, then the PT must suggest a physician from a list of available providers and inform the patient of the following limitations:
    • If no substantial progress has been made within 15 calendar days or six visits—whichever occurs first—after the patient’s initial visit, the physical therapist shall refer the patient to a licensed physician.
      • If the patient was previously diagnosed with chronic, neuromuscular, or developmental conditions, and the patient sought PT for problems or symptoms associated with at least one those conditions, then this provision does not apply.  
    • If the patient returns to PT with the same complaint within a 90-day timeframe starting on the last treatment date, then the PT must immediately refer the patient to the appropriate healthcare provider.
    • If the patient’s physician has not been notified that the patient sought physical therapy services, the therapy services must not continue beyond 30 days immediately following the date of the patient’s first visit.
• It is considered unprofessional conduct for a PT to knowingly provide services when a patient:
  • Has reached the 15-day and six-visit limit; or
  • Has reached the 30-day limit.

Texas

• Texas is one of six states that allow limited direct patient access to a physical therapist.
• PTs may not diagnose a disease.  
• After being licensed for one year, physical therapists may treat a patient for an injury or condition for which the patient was previously referred under the following conditions:
  • The PT notifies the referring provider within five business days of the start of therapy.
  • The PT must consult with the referring provider after 20 treatment sessions or 30 consecutive calendar days, whichever comes first.  
  • Treatment must commence within one year of the original referral.  
• PTs may provide assessments or instructions without a referral to any person presenting with no symptoms.

Utah

• Utah is one of 18 states that allow patients total, unrestricted access to a physical therapist. According to state law, no type of physician referral is required for a physical therapist to evaluate or treat a patient.
• PTs may not provide medical diagnoses of disease, surgery, acupuncture, or imaging.

Vermont

• Vermont is one of 18 states that allow patients total, unrestricted access to a physical therapist. According to state law, no type of physician referral is required for a physical therapist to evaluate or treat a patient, and there are no provisions to treatment.

Virginia

• Virginia is one of 26 states that allow direct patient access to PT with some provisions.
• A physical therapist who has obtained a doctorate of physical therapy or a certificate of authorization pursuant to Section 54.1-3482.1 may evaluate and treat a patient for no more 30 consecutive days after an initial evaluation without a referral, under the following conditions:
  • The patient is not receiving care from a licensed healthcare provider, a nurse practitioner acting in accordance with his or her practice agreement, or licensed physician assistant under supervision of a physician for the symptoms that prompted the patient to seek physical therapy services;
  • The patient identifies a licensed healthcare provider, a licensed nurse practitioner practicing in accordance with his or her practice agreement, or a licensed physician assistant under the supervision of a physician from whom the patient is currently receiving care;
  • The patient provides written consent for the PT to release all personal health information (PHI) and treatment records to the identified provider; and
  • The physical therapist notifies the specified provider within 14 days after the initial treatment and provides the provider with a copy of the initial evaluation along with a copy of the patient history.
• The PT shall not treat the patient for more than 30 consecutive days after evaluation without the referral of a licensed healthcare provider, nurse practitioner (in accordance with his or her practice agreement), or physician assistant acting under a licensed physician.
  • The physical therapist may contact the identified provider at the end of the 30-day period to obtain authorization of additional therapy services until the patient can be seen by the provider.
• A PT cannot perform an initial evaluation of the patient if the PT has performed an initial evaluation of the patient for the same condition within the past 60 days.
• A physical therapist who has not obtained a doctorate of physical therapy or certificate of authorization pursuant to Section 54.1-3482.1 can conduct a one-time evaluation of a patient. However, the therapist cannot provide treatment without a referral.
  • The PT must immediately refer the patient to an appropriate provider if necessary.
• Note that a PT can provide physical therapy services via direct access with no restrictions under the following circumstances:
  • To student athletes in a school setting;
  • For workplace ergonomics;
  • To special education students;
  • For wellness, fitness, and health screenings; and
  • For preventive services.
• Invasive procedures within the scope of PT practice may only be performed under the referral or direction of an appropriate healthcare provider, nurse practitioner, or physician assistant under the direction of a licensed physician.

Washington

• Washington is one of 26 states that allow direct patient access to PT with some provisions.
• Treatment may be administered with the following provisions:
  • A PT may only provide treatment using orthoses that are crucial to treating conditions of the foot or ankle by referral or consultation from an authorized healthcare provider.
• There is no restriction on any insurance entity or any state agency or program from limiting use of physical therapy services.  
• The PT must refer a patient to an appropriate healthcare provider when symptoms or conditions exceed the PT scope of practice.

West Virginia

• West Virginia is one of 18 states that allow patients total, unrestricted access to a physical therapist. According to state law, no type of physician referral is required for a physical therapist to evaluate or treat a patient.
• PTs may not conduct electromyography examinations and electrodiagnostic studies—other than for the purpose of determining chronaxia and strength duration curves—unless they are under the supervision of a licensed electromyographer and electrodiagnostician.

Wisconsin

• Wisconsin is one of 26 states that allow direct patient access to PT with some provisions.
• Treatment may be administered with the following provisions:
  • Written referral from an appropriate healthcare provider is required unless the PT services are provided:
    • In schools to children with exceptional education needs.
    • Within a home health care agency.
    • To a patient in a long-term care facility (if PT aligns with the patient’s plan of care).  
    • In relation to athletic activities, conditioning, or injury prevention.  
    • To an individual for a previously diagnosed medical condition after informing the patient’s healthcare provider who made the diagnosis.
• Per the physical therapy examining board regulations:
  • Referral is not required for the following services when provided in employment, home, leisure, recreational, or educational settings:
    • Conditioning;
    • Injury prevention and biomechanics application; and
    • Treatment of musculoskeletal injuries, excluding acute fractures or soft tissue avulsions.
  • The PT must refer a patient to an appropriate healthcare provider if necessary services exceed the PT scope of practice.
  • A physical therapist who receives a referral shall communicate with the referring provider as necessary to ensure continuity of care.

Wyoming

• Wyoming is one of six states that allow limited direct patient access to a physical therapist.
• A PT may only treat direct access patients with the following provisions:
  • A physical therapist with a master’s degree—or with a bachelor’s degree and five years of clinical experience—may initiate treatment for a new or recurring injury without a prescription.  
  • A PT may treat a patient for a chronic or recurring injury or condition without a prescription as long as the patient was previously diagnosed and prescribed PT treatment within the previous year.  
  • Except in emergency situations, a PT cannot initiate therapy for children under the age of 12 without a prescription. The exception to this is if the child is to receive PT treatment in accordance with an education program or family services plan.  
• A PT must refer the patient to a physician when:
  • The physical therapist believes there are symptoms or conditions present that require services exceeding his or her scope of practice;
  • PT treatment is contraindicated; or
  • The patient has received therapy services without a prescription for 12 visits or 30 days—whichever comes first—and further treatment is necessary.
    • The exception to this is for patients participating in exercise or fitness programs or receiving PT services under an education program or family services plan.

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It’s my hope that this information will empower every physical therapist in the US to grow his or her practice and promote PTs as the go-to providers for patients in need of musculoskeletal care. After all, there’s no healthcare professional who receives more training in the treatment of these types of diseases and injuries than a physical therapist does.

Want all of this information in one handy, easy-to-read guide? Download The PT’s Guide to Direct Access Law in All 50 States and find out how you can become the go-to provider for musculoskeletal injury in your area.