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 vary greatly depending on which state you practice in. For example, the laws around direct access to physical therapy in California may differ significantly from those in Florida. So, with that in mind, I’m digging through the ins and outs of direct access law by state and presenting you with all the need-to-know facts over the next four days.

Before we get too deep into the thick of things, here’s a quick disclaimer: I’m not a compliance or legal expert, and all of the following information was sourced from this APTA document. So, before you evaluate any direct access patients, be sure to consult with your attorney or a PT compliance professional. With that said, I hope you’re wearing some comfy shoes, ’cause we’re about to cover a lot of ground.

Alabama

Alaska

• Alaska is one of 20 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to treat a patient.
• However, if the patient’s condition is beyond the PT’s scope of practice, the therapist is obligated to refer the patient to another qualified healthcare provider. Failure to do so can result in license revocation or suspension.

Arizona

• Arizona is one of 20 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to treat a patient.
• While direct access to a physical therapist is not restricted in Arizona, a PT must refer a patient to the appropriate healthcare provider if he or she feels the patient’s condition is beyond the physical therapy scope of practice or if physical therapy is contraindicated.

Arkansas

• Arkansas is one of 28 states that allow direct patient access to PT with some provisions.
• In Arkansas, the only provision applies to treatment for bronchopulmonary hygiene, debridement, and wound care. In these instances, a physician referral is required.

California

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Colorado

• Colorado is one of 20 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to treat a patient.
• State law prohibits PTs from diagnosing diseases.
• If a PT believes the patient’s care exceeds the physical therapy scope of practice, the therapist must refer the patient to a qualified healthcare provider. Failure to do so can result in disciplinary action.

Connecticut

Delaware

• Delaware is one of 28 states that allow direct patient access to PT with some provisions.
• Delaware law allows treatment from a PT with or without referral from a licensed medical or osteopathic physician.
• A PT can treat a patient for up to 30 days, after which the therapist must consult a physician.
• If the patient’s condition requires care that falls outside of the PT scope of practice, then the PT must refer the patient to a qualified healthcare provider.
• A PT may not modify a patient’s existing prescriptions.

District of Columbia

• The District of Columbia—along with 28 US states—allows direct patient access to PT with some provisions.
• If the patient does not reasonably progress within 30 days of care, the PT must refer the patient to a primary care provider.

Florida

• Florida is one of 28 states that allow direct patient access to PT with some provisions.
• If the patient’s condition falls outside of the PT scope of practice, the PT must refer the patient to, or consult with, a qualified healthcare practitioner.
• If the PT care plan exceeds 30 days and the condition has not been assessed by a physician of record, then the PT must have a practitioner of record review and sign the plan. However, this does not apply if (1) the patient has been examined by a physician in a different state and diagnosed by the physician as having a condition for which PT is required, and (2) the PT is treating that specific condition. 
• PTs may not implement a treatment plan for patients in an acute care setting such as a hospital, ambulatory surgical center, or mobile surgical facility.

Georgia

Hawaii

• Hawaii is one of 20 states that allow patients total, unrestricted access to a physical therapist. No type of physician referral is required for a physical therapist to treat a patient.
• While direct access to a physical therapist is not restricted in Hawaii, a PT must refer a patient to the appropriate healthcare provider if the therapist feels the patient’s condition is beyond the physical therapy scope of practice or if physical therapy is contraindicated. Failure to do so is considered an act of professional misconduct.

You might be thinking, “Wait a minute, that’s only 12 states! Didn’t you say that all 50 states are direct access-friendly?” Rest assured: If your state wasn’t covered this time around, I’ll tackle it in one of the next three posts. But, if you’re not a fan of cliffhangers, then you can get all the info you need by downloading our free PT's Guide to Direct Access Law. Otherwise, I’ll be back Monday—same time, same place—covering direct access laws from Idaho to Mississippi.