Skip to main content

The Issue

Medicare permits general supervision of physical therapist assistants by physical therapists in all settings — except for outpatient private practice under Part B, which requires direct supervision. Physical therapists and physical therapist assistants are governed by their state's practice act and must follow their state licensure requirements if they are more stringent than Medicare’s. However, 49 states permit "general supervision" of physical therapist assistants in outpatient practices, making Medicare’s direct supervision requirement in that setting more burdensome than most state licensure requirements.

Why It Matters

PTAs play a crucial role in the PT-PTA team and help bridge the gap in access to care. Instead, the current direct supervision requirement makes it harder for this access to be provided and threatens physical therapy businesses, particularly in rural and underserved areas where beneficiaries are 50% more likely to receive therapy from a PTA. Enactment of the EMPOWER Act (H.R. 4878/S. 2459) would standardize the supervision requirement from direct to general for private practices, help ensure continued patient access to needed therapy services, and give practices more flexibility in meeting the needs of beneficiaries.

Stay Up to Date

APTA members can join the APTA Advocacy Network for free to receive action alerts on federal legislative issues and more.


Recommended Content

Position Paper: EMPOWER Act

Mar 22, 2024 / Position Paper

Final 2022 Fee Schedule: Cuts, PTA Differential Remain — Focus Turns to Congress

Nov 3, 2021 / Review

APTA-Backed Bipartisan House Bill Takes Aim at PTA Differential

Oct 13, 2021 / News

The PTA Differential: History, What We're Doing, and Your Role in the Fight

Aug 20, 2021 / Open Access

APTA, AOTA, Other Groups Ask Congress for Intervention on PTA Differential

Aug 4, 2021 / News


Additional Eliminating the Direct Supervision Requirement of PTAs under Medicare Part B Content

Aetna Launches PTA Differential

Mar 15, 2024 / News

After putting the move on hold for three months, the insurer implemented the reduction March 1.

Win (for Now, at Least): Aetna Backs Away From PTA Differential

Nov 1, 2023 / News

Aetna put its decision on hold, giving APTA time to press for a permanent shift. Other news from the insurer isn't as good.

Members-Only Payment Advocacy Resource Collection Grows

Mar 21, 2023 / News

The resource center, created by APTA and APTA Private Practice, now offers information on MPPR, the PTA differential, and more.

APTA Advocacy Roundup: What's Been Passed by Congress, What's Still on the Table

Sep 20, 2022 / Roundup

Here's the status of APTA-supported legislation on the fee schedule, telehealth, prior authorization, the PTA differential, and more.

Study Bolsters the Case for SMART Act

Sep 7, 2022 / News

Policy research cosponsored by APTA reveals potential savings through eased PTA and OTA supervision requirements.

7 Conversations to Have With Your Legislators While They're Back Home in August

Aug 1, 2022 / Roundup

District offices, town halls, maybe a visit to your clinic? Here are some topics worth mentioning.

House Members Push for Better PTA, OTA Supervision Rules Under Medicare

May 10, 2022 / News

Representatives are urging an APTA-backed move to general supervision for PTAs in outpatient settings.

Spending Package: A Win for Telehealth, No Movement on PTA Differential

Mar 11, 2022 / News

The $1.5 trillion plan passed with bipartisan support. Here are three takeaways of interest to the physical therapy community.

APTA, Lawmakers Press for Payment Relief by March 11 Deadline

Mar 8, 2022 / News

Remember that old saying, "strike while the iron is hot"? Things are hot on Capitol Hill (and there's still time to act).

APTA and Patient, Provider Groups Continue PTA Differential Push

Feb 9, 2022 / News

In a joint letter to congressional leaders, APTA and 11 other groups urge adoption of legislation to address the PTA payment cut.