If you haven’t been keeping up with the WebPT Blog over the past few days, here’s what you’ve missed: I’ve been breaking down all of the state-level direct access laws from coast to coast. (You can check out the laws for Alabama to Hawaii here and Idaho to Mississippi here.) If you have been keeping up, then welcome back! (Cue the “Welcome Back, Kotter” theme song.) Today, I’m tackling the laws from M to P—that’s Missouri to Pennsylvania. But, as I’ve stated in the previous two posts, I’m not a legal expert. So, before you start evaluating and/or treating patients sans physician referral, be sure to consult with an attorney or PT compliance expert. Now, let’s get back to it:

The State of Rehab Therapy Report Wood - Regular BannerThe State of Rehab Therapy Report Wood - Small Banner

Missouri

  • Missouri is one of six states that allow limited direct patient access to a physical therapist.
  • A physical therapist may only see direct access patients under the following circumstances:
    • When the therapist is providing services for educational purposes and training, developing fitness or wellness programs, or providing screenings or consultations.
    • When the therapist is treating a patient with an injury or condition that could resolve itself without therapy, and that patient received the diagnosis within one year or has a chronic illness that has been previously diagnosed by an appropriate healthcare provider.
      • In this instance, the physical therapist must:
        1. Contact the patient's current healthcare provider within the first seven days of therapy.
        2. Not alter any existing PT referrals without the consent of the patient's current healthcare provider.
        3. Refer the patient to an appropriate healthcare professional if the PT determines during the initial evaluation or treatment that the patient’s care goes beyond the physical therapy scope of practice.
        4. Refer the patient to an appropriate healthcare provider if he or she does not show any documented progress toward treatment goals within six visits or 14 days.
        5. Notify the patient's current healthcare provider if treatment continues beyond 30 days.
          1. The PT must contact the patient’s provider prior to the continuation of treatment.
          2. The PT must provide notification every 30 days.

Montana

  • Montana 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.
  • 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.
    • Failure to do so will result in license revocation.

Download the PT's Guide to Direct Access Law in All 50 States.

Enter your email address below, and we’ll send you a comprehensive guide to direct access laws in your area.

Please enable JavaScript to submit form.

Nebraska

  • Nebraska is one of 18 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to evaluate or treat a patient.
  • 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.
  • Failure to do so is considered unprofessional conduct.

Nevada

  • Nevada is one of 18 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to evaluate or treat a patient.
  • The state’s direct access law specifies that diagnosis of physical disabilities, massage services, and chiropractic adjustment do not fall under the physical therapy scope.

New Hampshire

  • New Hampshire is one of 26 states that allow direct patient access to PT with some provisions.
  • A PT must refer a patient to an appropriate healthcare provider:
    • If the PT feels that the patient’s care goes beyond the physical therapy scope of practice.
    • If physical therapy treatment is contraindicated.
    • If the patient shows no documented progress within the first 25 calendar days of therapy.

New Jersey

  • New Jersey is one of 26 states that allow direct patient access to PT with some provisions.
  • A PT treating direct access patients is contingent upon the following:
    • A PT shall refer a patient to a healthcare professional licensed in this state to practice dentistry, podiatry, medicine, or surgery—or another appropriate licensed healthcare professional:  
      • When the PT performing the examination, evaluation, or intervention has reason to believe that therapy is contraindicated or symptoms or conditions are present that require services outside the physical therapy scope of practice; or  
      • When the patient has failed to demonstrate reasonable progress within 30 days of the date of the initial treatment.
    • Within 30 days from the date of initial treatment, a physical therapist shall inform the patient's licensed healthcare professional of record of the patient's plan of care.
      • In the event that there is no identified licensed healthcare professional of record, the physical therapist shall recommend that the patient consult with a licensed healthcare professional of the patient's choice.
      • In a school setting, the schedule of PT services shall be reported to a child study team by the physical therapist within 30 days of the date of initial treatment.

New Mexico

  • New Mexico is one of 26 states that allow direct patient access to PT with some provisions.
  • In order for a PT to treat direct access patients:
    • The PT must refer a patient to the patient’s licensed healthcare provider if the patient has not made measurable or functional improvement 30 days after starting therapy treatment.
      • If the patient is making measurable progress and improving, the 30-day limit does not apply.
      • The 30-day provision also does not apply to:
        • Treatment provided for complaints related to chronic neuromuscular or developmental conditions for patients previously diagnosed with such a condition.
        • Health promotion, wellness, fitness, or health maintenance services.
        • Services provided to patients who are, under federal law, participating in programs involving an education or family service plan.

New York

  • New York is one of 26 states that allow direct patient access to PT with some provisions.
  • Treatment may be administered with the following provisions:
    • A licensed PT may treat a patient without a referral for 10 visits or 30 days, whichever comes first.  
    • The PT must have at least three years of full-time practicing experience.
    • The PT must be at least 21 years old.  
    • The PT must notify the patient that PT services might not be covered by the patient’s health insurer if he or she did not receive a referral for PT.
      • Notification must be in written form.
      • Notification must also state that said services could potentially be covered by the health insurer with a referral.
      • The PT must keep a copy of the written notification in the patient’s file.

North Carolina

  • North Carolina is one of 26 states that allow direct patient access to PT with some provisions.
  • Treatment may be administered with the following provisions:
    • Spinal manipulation must be prescribed by a physician.  
    • PTs may not determine medical diagnosis.
  • 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.
    • Failure to do so is considered unlawful practice.

North Dakota

  • North 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.
  • 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.
    • Failure to do so will result in license revocation.

Ohio

  • Ohio 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 obtain a master’s degree or have two years of clinical experience.
    • If the patient does not demonstrate progress within 30 days, the PT must refer him or her to an appropriate healthcare provider.  
    • The PT must notify the patient’s healthcare provider within the first five days following the initial PT evaluation.
    • The PT may only apply certain orthotic devices.

Oklahoma

  • Oklahoma 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 obtain a physician’s referral after 30 days.
    • Patients must obtain a physician’s referral if they are seeking PT for any workers’ compensation claims.

Oregon

  • Oregon 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.
  • The PT must refer the patient to an appropriate healthcare professional if the person presents symptoms:
    • That require treatment or diagnosis from a physician;
    • For which PT is contraindicated; or
    • For which care is beyond the scope of practice or education of a physical therapist.

Pennsylvania

  • Pennsylvania is one of 26 states that allow direct patient access to PT with some provisions.
  • Treatment may be administered with the following provisions:
    • Licensee may obtain certification from the board of physical therapy that allows him or her to practice without a physician’s referral.  
      • This certificate shall not authorize a PT to (1) treat a patient for any non-neurologic, non-muscular, or non-skeletal condition or (2) treat a patient who has an acute cardiac or acute pulmonary condition.
      • The PT may treat the aforementioned patients only if he or she has consulted the patient's healthcare provider or has referred the patient to an appropriate healthcare provider.  
      • The certificate holder shall publicly display the certificate.  
      • The PT shall renew the certificate whenever he or she renews his or her therapy license.
      • A PT with this certification may treat a direct access patient for 30 days from the date of the first treatment.
        • The PT may not exceed 30 days of treatment without obtaining a referral from an appropriate healthcare provider.

Three posts down; one more to go! Tomorrow, I’ll be tackling all the laws from Rhode Island to Wyoming. So, if you practice in any states between R and W, be sure to swing by the WebPT Blog for the final installment of this series. And, of course, if you want to have direct access law for all 50 states compiled in one, easy-to-read document, The PT’s Guide to Direct Access in All 50 States is available for download right here. Until next time!

  • The PT's Guide to Direct Access Law in All 50 States Image

    downloadDec 8, 2017

    The PT's Guide to Direct Access Law in All 50 States

    As of 2015, all 50 states are direct access states. That means patients across the entire US have the power to choose which physical therapist they want to see, and they can do so without first obtaining a physician referral. There’s just one caveat: Each state has its own unique set of laws that lay out the terms of direct access. Not only that, but these laws are frequently adjusted and updated—and they’re usually encrypted in all …

  • Direct Access Laws by State (Idaho-Mississippi) Image

    articleDec 11, 2017 | 9 min. read

    Direct Access Laws by State (Idaho-Mississippi)

    Yesterday, I broke down the what’s what of direct access laws by state, starting in Alabama and ending in Hawaii . Today, I’m continuing our guided tour of direct access law by kicking things off in Idaho and making our way down the list to Mississippi. (Don’t worry about gas money: we’ll do it all from the comfort of our homes or offices.) Just to reiterate, I’m not a legal or compliance expert, and all of the …

  • Direct Access Laws by State (Alabama-Hawaii) Image

    articleDec 8, 2017 | 10 min. read

    Direct Access Laws by State (Alabama-Hawaii)

    If you’re a physical therapist—and you’re licensed in the United States—then you’re practicing in a direct access state. That’s right: In all 50 states—as well as the US Virgin Islands and DC—direct access to at least a physical therapy evaluation is the law of the land. But, before you start seeing every patient who walks through your door without a physician referral, there are a few things you ought to know. The laws around direct access can …

  • Video Tutorial: Selecting the Correct Complexity Level for PT and OT Evals Image

    articleOct 13, 2016 | 1 min. read

    Video Tutorial: Selecting the Correct Complexity Level for PT and OT Evals

    The holidays will be here before we know it—and that means PTs and OTs will be required to use the new evaluation and re-evaluation CPT codes before we know it, too. And these codes bring with them the gift of complexity. But, unlike that snowman sweater from Great Aunt Sheila, therapists can't exchange these codes; so, whether they want to or not, PTs and OTs have to learn the ins and outs of coding for evaluative complexity …

  • Common Questions from Our Cash-Based Physical Therapy Webinar Image

    articleAug 30, 2017 | 19 min. read

    Common Questions from Our Cash-Based Physical Therapy Webinar

    Earlier this week, WebPT’s president and co-founder, Dr. Heidi Jannenga, PT, DPT, ATC/L, teamed up with cash-based physical therapy guru Dr. Jarod Carter, PT, DPT, MTC, to host a webinar covering all things cash pay —from insurance contracting considerations and Medicare rules to self-referral marketing and service pricing. Thousands of rehab therapy professionals registered to attend, which means we received a ton of questions—so many, in fact, that there was no way we could answer all of …

  • Common Questions from Our New PT and OT Evaluation Codes Webinar Image

    articleDec 19, 2016 | 20 min. read

    Common Questions from Our New PT and OT Evaluation Codes Webinar

    This month’s webinar on the new CPT codes was our biggest one yet—more than 11,000 people registered to attend. With such a large—and clinically diverse—audience, we received a ton of questions. And due to time constraints, our hosts—WebPT’s own Heidi Jannenga and compliance expert Rick Gawenda—weren’t able to get to even a fraction of them during the live broadcast. Not to worry, though; we’ve done our best to answer them all here, in one giant FAQ article. …

  • CPT Update: Why the Valuation of the New PT and OT Eval Codes is Problematic Image

    articleJul 19, 2016 | 9 min. read

    CPT Update: Why the Valuation of the New PT and OT Eval Codes is Problematic

    The purpose of any type of reform is to drive change. And that’s certainly true when it comes to healthcare—and healthcare payment—reform. But, change often comes slowly—and in the wake of Medicare’s recently issued proposed physician fee schedule for 2017 , I have to wonder whether it’ll come too slowly for physical and occupational therapists. That’s because, while the Centers for Medicare & Medicaid Services (CMS) voiced its support for replacing the existing CPT codes for physical …

  • Founder Letter: My Evaluation of the New PT and OT Eval Codes Image

    articleNov 3, 2016 | 5 min. read

    Founder Letter: My Evaluation of the New PT and OT Eval Codes

    Over the last several years, healthcare providers in general—and rehab therapists, specifically—have been hit with a seemingly constant barrage of regulatory requirements. And the vast majority of these initiatives—PQRS, functional limitation reporting, MPPR, ICD-10, and the like—have either: Had a direct negative impact on our payments, or Forced us to devote extra time to satisfying the criteria of the requirements—with zero compensation for that time. So, it should come as no surprise that the rehab therapy community …

  • New Year, New Codes: How to Bill for PT and OT Evaluations in 2017 Image

    webinarOct 27, 2016

    New Year, New Codes: How to Bill for PT and OT Evaluations in 2017

    As we prepare to ring in the new year, PTs and OTs also must prepare to ring in a new set of CPT codes for therapy evaluations and re-evaluations. That’s right—the ball isn’t the only thing dropping on January 1, 2017. On that day, all of the existing PT and OT evaluative codes—including 97001, 97002, 97003, and 97004—are fading into the annals of history. In their place will be eight new codes: three for PT evals, three …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.