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Direct access to PT services is a reality across America, but not without challenges.
Every state, the District of Columbia, and the U.S. Virgin Islands has lifted all or some of the referral requirements or order provisions for physical therapist evaluation and treatment, meaning that PTs can provide evaluation and treatment services without the need for an order or referral from any other health care professional in accordance with state law.
But there are more gains to be made. Your advocacy support is needed as we continue to fight for more effective direct access provisions at the state and federal levels. And while Medicare also allows direct access, providers must carefully follow rules and regulations.
Recommended Content
May 3, 2020 / Article
Achieving direct access has been a major initiative for APTA and its chapters. While it has been achieved in some form across the country, APTA continues to advocate for unrestricted direct access everywhere. Physical therapists should take advantage of the
May 4, 2020 / Article
Medicare beneficiaries can go directly to physical therapists without a referral or visit to a physician.
Apr 24, 2020
More needs to be done to improve direct access in states across the country.
Additional Direct Access in Practice Content
Sep 17, 2025 / Podcast
Jun 25, 2025 / Report (Open Access)
APTA’s "State of Direct Access to Physical Therapist Services" report is a strategic resource designed to equip health care leaders with the scientific evidence they need to address opposition to direct access and drive meaningful change.
Jan 26, 2022 / Podcast
Topics covered include direct access, the physical therapy compact, telehealth, and more.
May 3, 2020 / Article
CMS has specific regulations that impact direct access services in hospital-based outpatient settings.
Feb 12, 2020 / Article
PTs have all the training and skills necessary to provide diagnosis and treatment without a physician’s referral and without arbitrary restrictions.
Aug 9, 2019 / Podcast
As more PTs transition into direct access roles, it seems prudent to consider how additional resources common to other first-contact providers might impact patient care.
Aug 15, 2018 / Podcast
Julie Sexton, PT, and Michelle Ramirez, PT, DPT, discuss their health system’s process for translating evidence into practice and expanding care through direct access.
Mar 19, 2018 / Podcast
Kenneth Harwood, PT, PhD, discusses research that studies whether unrestricted direct access to physical therapist services lowers utilization and health care costs for people with low back pain.
Oct 20, 2017 / News
Most of the use is occurring in private and hospital-based outpatient clinics and group practices.