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  • New Wisconsin Law Allows PTs to Order X-Rays

    Physical therapists (PTs) in Wisconsin now have a big addition to their licensing law: the ability to order x-rays. The change, signed into law by Gov Scott Walker on April 25, marks the first time any state has specifically authorized PTs to make the decision.

    Under the new law, to be able to order x-ray imaging, the PT must hold a clinical doctorate degree or a specialist certification, or have completed a board-approved residency or fellowship, or a formal X-ray ordering training "with demonstrated physician involvement."

    The law also requires the PT to communicate the x-ray order to the patient's primary care physician "or an appropriate health care practitioner" to ensure coordination of care. That communication is not required if the patient doesn't have a primary care physician or was not referred to the PT by another practitioner, or if the radiologist doesn't identify a significant finding.

    According to Angela Shuman, APTA's director of state government affairs, the Wisconsin law is historic because it's the first time a state PT licensing law has specifically listed ordering x-rays as within a PT's scope of practice.

    "No other state PT practice acts specifically say that PTs can order x-rays—the laws are mostly silent on the matter," Shuman said. "This lack of specific language can make it difficult for PTs to understand just what they can or can't do, but Wisconsin has taken the step to make things very clear." The state has also changed the licensing law for the individuals who perform radiologic procedures such as x-rays, specifying that they can now accept orders from licensed PTs, she explained.

    APTA, the Wisconsin Physical Therapy Association, and supporters worked for more than 2 years to advocate for the new law.

    The bill was sponsored by Rep Joe Sanfelippo in the Wisconsin State Assembly, with a companion bill in the state senate sponsored by Sen Van Wanggaard. The bill becomes effective the day after it is electronically published by the state's Legislative Reference Bureau.

    Comments

    • It is comical that the law states that PTs must inform the physician of the results for "coordination of care" yet for all these years we struggle to obtain results from our medical colleagues that also is important for coordination of care.

      Posted by Tracy Urvater on 4/25/2016 8:06 PM

    • Another great State leads us further towards full autonomous PT practice! Congratulations to Wisconsin PTs on this achievement! Thank you from a hopeful PT in California! May the rest of the States and Territories now quickly follow suit.

      Posted by Lise McCarthy on 4/26/2016 12:14 AM

    • Where are all the other states??? This looks like a very good use of membership dollars and PAC efforts and accomplished in only 2 years!!!There are other things that we have been spending money and efforts on for literally 30 years (POPTS)and have very little to show for it. Let's drop the old and start building new with efforts that elevate our profession instead of fighting a profession that will self destruct on its own....

      Posted by beth scott on 4/26/2016 10:22 AM

    • I wonder if this will be like direct access? You can order it but no insurance company will cover it! It is always interesting how insurance coverage is left out of most of these conversations. Especially with the general high cost of health care.

      Posted by Cristian Prado on 4/26/2016 10:29 AM

    • This is wonderful. Let's mobilize and make this happen in all states!

      Posted by Jonathan Sum on 4/26/2016 3:30 PM

    • other states shld follow. xrays and other imaging techniques are still the best diagnostic tools, our tests special or provocative doesnt confirm the pathologies. besides it will delay making the decision to intervene if PT's will wait for the primary care doc to arrive at a decision to go for xrays. I think non-DPT PT's with or without the said further educ shld be extended same privilege, xray findings will still be interpreted by the radiologist anyway. this will enhance further the interdisciplinary approach.

      Posted by romeo robles rpt on 4/26/2016 10:33 PM

    • If most states are silent on the matter, how come PTs don't order X-Rays more often? I work in New Jersey and would love more information on the matter! Thanks!

      Posted by Robert on 4/27/2016 12:57 AM

    • I think imaging is indicated I make a call. I've yet to have a doctor say, "Gee, do you really think so?" when I say someone needs it. Usually they're all over it. Of course I reference Ottawa and other standards, and explain what I am saying. I've just not found them terribly informative in providing care most of the time. I've had MD's hold on PT pending imaging to "find out what's going on". Silliness. Most of the time a decent H&P will tell you what's going on. It's then you've got to decide if imaging is indicated. Not before.

      Posted by Leon A. Richard on 4/27/2016 3:41 PM

    • This is a good start, but civilian PTs are still far too limited in their scopes of practice. We've been ordering imaging, prescribing meds, ordering lab tests, etc, etc, in the military for decades. I realize that getting legislation passed takes time, but our military model has shown for a long time that PTs are more than capable of handling primary care MSK issues.

      Posted by Michael on 4/27/2016 3:50 PM

    • Another great advance in physical therapy practice. It should be allowed in other states too.

      Posted by Sanjay on 4/27/2016 3:53 PM

    • This is in no doubt good news for Physical Therapy practice, not only in Wisconsin but hopefully other States can learn from this. However, I do have some concern that PT in many other countries have been enjoying this privileged for over a decade especially in the area of Musculoskeletal radiology. One example is England where if you operate as a Senior PT and as an Extended Scope practitioner, you could order some x-ray related to PT in the area of musculoskeletal, read and make diagnosis and treatment decision based on this. I hope that many other States will follow the example laid by Wisconsin so that our DPT status will have a real difference in what we could or could not do.

      Posted by Sola Oshunniyi PT, DPT on 4/27/2016 3:54 PM

    • This is historic legislation but the ordering of imaging to help determine a functional impairment is already within the scope of practice for us physical therapists in NJ. It just hasn't been utilized. As a member of the NJ Board of Physical Therapy Examiners, we have recently taken up this issue to ensure our licensees are best utilizing the services available to them for making clinical decisions. Stay tuned.

      Posted by David Bertone, PT, DPT, OCS on 4/27/2016 3:57 PM

    • Physical Therapists are trained in school to do a physical therapy examination which includes history of pt symptoms, gonimetric measurements, MMT, PT special tests and physical therapy diagnosis. They are also trained in differential diagnoses. It is heavily emphasized in PT school that when a pt presents symptoms to a PT that are outside the PT's scope of practice, it is the PT's job according to the PT practice act; to refer the pt to the proper healthcare provider(i.e. a physician). There is no need to order X-rays since PTs are not trained to read them and formulate a medical diagnosis. This why PTs are DPTs not MDs!! Those PTs that want to order and read x-rays should go to medical school where you are properly trained to do so. Introduction to Radiology ( a newly added course to the DPT curriculum) does not qualify a PT to do so(according to most PT curriculum's course description)

      Posted by Keith Chittenden on 4/27/2016 4:02 PM

    • Congratulations to Wisconsin for leading the way! This is a great accomplishment, and sets the bar for the rest of us. You accomplished this in two years, but I'm sure that's because you have spent the time necessary to have a positive, working relationship with your legislators. Way to go!!!

      Posted by Janet Downey, PT, PCS on 4/27/2016 4:03 PM

    • I contacted one of the largest imaging centers in my state to find out their imaging study requirements. I was informed that x-rays didn't require pre-auth, but MRI did. The imaging center provided me with imaging request forms. So, when I order x-rays I just send my patients with one of the imaging request forms to one of the imaging centers convenient for them. The imaging center then faxes me the radiologist report. I can even access the images online if needed.

      Posted by Sumesh Thomas on 4/27/2016 4:34 PM

    • With direct access to P.T. laws in most of the states now, ordering x-rays as needed should also be allowed.This way we can have radiological diagnosis from radiologist and we can take better care of our patients. Congrats Wisconsin PTs!

      Posted by Sanjay on 4/27/2016 4:43 PM

    • This is certainly a move in the right direction for autonomy in our profession. What steps will the APTA take to make this a nationwide outcome? Will insurance companies pay for PT referred radiographs? How quickly can we see this first step becoming a nationwide leap forward?

      Posted by Cheryl Durant on 4/27/2016 4:43 PM

    • When I was a civilian PT for the Army in Hawaii we could order any imaging we wanted, including bone density and CT/MRI with contrast. There was never an issue with PTs ordering inappropriate imaging, and almost without fail if we decided to order imaging there was a significant finding. We could also directly put in consults to Ortho, Neuro, Rheum, etc. The scope of practice when working with the military is far beyond any state licensing - it would behoove our APTA representatives to get a hold of the scope of practice documents for the military and then use that information to make the case nationally (along with the vast research the Army has amassed proving that PT is the most efficient way to triage physical injuries).

      Posted by Jennifer Simpson on 4/27/2016 4:56 PM

    • Because the APTA is useless. PT is the most underpaid medical profession, and we're only getting less and less each year, while tuition and pre-reqs continue to increase.

      Posted by blogan on 4/27/2016 5:01 PM

    • Congrats to Wisconsin PTs. Colorado PTs have been able to order x-rays and MRIs since 21 MAR 2014. From the Colorado Practice Act, "A licensed physical therapist may order or perform, with clinical justification, any diagnostic imaging which is within the recognized standards of the practice of physical therapy, including magnetic resonance imaging (MRI)." I agree with the comments above; however, shouldn't PT in Motion have known of any other states like Colorado that already have this right. Moreover, military PTs have been ordering diagnostic imaging for over 40 years. In short, every chapter in the US should be fighting for this capability. There is a huge amount of data not only in the US but in other countries (Canada, Australia, Britain) regarding the benefits of PT ordering diagnostic tests. PTs typically order 50% fewer images that MD and other health professionals with similar outcomes and actually improved patient satisfaction. Looks like we have more work to do in our profession.

      Posted by Evan Kelley on 4/27/2016 6:33 PM

    • Diagnostic imaging (radiographs, CT scans, MRI, and ultrasounds) ordering rights were added to Colorado's PT practice act last year, although insurance coverage for those orders has been variable.

      Posted by Peter Van Doren, PT, MSPT on 4/27/2016 6:37 PM

    • In Georgia, pretty much all insurance companies pay for direct access. For at least 10 years they have reimbursed for PT without a physician order. Our practice act required us to "consult with a practitioner of the healing arts" and I would just send an evaluation to the patients doctor. I would not as for a referral and have never had problems turning the billing in to the insurance company and getting paid. I would like to know what states people find that they need a referral to get paid (except for Medicare which actually does not require a referral in order to complete an evaluation at least to the best of my understanding).

      Posted by Herbert Silver -> >JX^D on 4/27/2016 6:45 PM

    • I should add AWESOME JOB. Having worked with legislative issues for years in Georgia, I can't imagine how difficult this must have been to pull off. Thanks for leading the way. Anyone who hasn't been involved in legislative issues, don't believe for a second that even though it went through in 2 years, there were bunches of PTs in that state pushing hard to make it happen. I am truly in awe. Great, great job!!

      Posted by Herbert Silver -> >JX^D on 4/27/2016 6:47 PM

    • Good news. Wisconsin PT is going in the right direction. Other States PT boards should follow. Recognition of Diagnostic Ultrasound (non invasive type) should also be pursued as a PT diagnostic tool.

      Posted by Riaz Khan, PT, DPT on 4/27/2016 7:01 PM

    • Very proud of my Wisconsin colleagues! Kudos to all involved in the two year process. I'm fortunate to practice physical therapy in this great state. Wonderful forward progress by a very motivated group of amazing PTs!! Awesome!

      Posted by Lori Webster-Dahl on 4/27/2016 7:30 PM

    • This is truly monumental! Job well done, Wisconsin PTs. I have waited for this day for a long, long time. This means we will be able to make another huge step in autonomy in healthcare. This will help us move one step closer at being the first caregiver for those with musculoskeletal problems; therefore, we will be able to have a 'say so' in referring them to other specialists, eg Orthos. This could change the playing field for the betterment of PTs.

      Posted by Mark Waldrop on 4/27/2016 9:17 PM

    • Its my understanding that PTs in the military are able to order imaging. I'm surprised this hasn't caught on sooner. Hopefully this will be the push we need to make it spread through out the states. I wonder also if this will only only apply to outpatient PT or if our inpatient colleagues will be included as well?

      Posted by Geanna Granger on 4/27/2016 9:32 PM

    • Beware of the "law of unintended consequences." With additional clinical responsibilities, comes the potential for litigious activity for a variety of reasons- beginning with outrageous- that will expose the professionals availing themselves of this new function to legal quagmires.

      Posted by Herschel Budlow P.T. on 4/27/2016 10:37 PM

    • @Keith Chittenden...Educate yourself on the military model of physical therapy and then you will understand, at least to some degree, that physical therapists should be one of the primary providers for MSK injuries. Ordering imaging is part of the scope of practice of any primary provider for MSK. If you are jealous or upset because you are a family medicine physician, I would recommend bringing that up to the AMA or AAFP. This territorial battle over who can and who can't do something is ridiculous. It is a ploy for physicians to charge more for something that can be done by someone who is well trained in MSK DDX regardless of their degree or title.

      Posted by kevin on 4/28/2016 8:19 AM

    • I think, Dr. Keith Chittenden, you are a doctor of chiropractic. Is this correct? If so, I am not sure why you would think it appropriate for you to try to re-define PT scope of practice. http://www.drkeith.co.za

      Posted by Lise McCarthy on 4/28/2016 1:54 PM

    • Congratulations Wisconsin on your successful efforts. I hope you are still celebrating this incredible accomplishment. I would like to see our comments and posts be simply celebratory and for us to "lighten up" on this thread... there are other venues for your "discussions". We have witnessed a chapter invest significant resources and have experienced success in a difficult legislative process... let's continue to congratulate Wisconsin on their success!! Again, congrats and thanks Wisconsin!!

      Posted by George Coggeshall -> @HQa on 4/29/2016 9:19 AM

    • This is so exciting. Congratulations Wisconsin! I hope this means other states will follow through and that this will only improve the MD-DPT relationship for the benefit of the patients!

      Posted by Kyle Salcedo on 5/1/2016 1:47 AM

    • Michigan is one of those states that you need a doctor to sign the plan of care to get paid. For some insurances, the doctor needs to have written a rx for therapy prior to the eval date. It's investing to read the vast differences that we have throughout this country. I agree that with some insurance only a doctors script for an xray would be covered.

      Posted by Jill Zueski on 5/5/2016 10:24 PM

    • This is so exciting. Congratulations Wisconsin! I hope this means other states will follow through and that this will only improve the MD-DPT relationship for the benefit of the patients!

      Posted by Kyle Salcedo -> CKX]=K on 5/25/2016 4:58 PM

    • If the PTs in Michigan would come together as one and support the MPTA and the PACs in the state we can ruffle feathers and land a big one like was done in Winsconsin, and displace the large elephant in the room which has dominated, manipulated the Michigan legislature for years, the MDs. I do agree that PTs can triage MSK injuries better than PCPs , we need to be more united and supportive and not just talk about it, but actually do something about it,and generally the rest of the country need to follow the army model, which will increase our liability but help to fulfill our calling as PTs, and lastly the APTA need to push for an increase in pay for PTs Posted by Adeyinka Fagbamila 5/28/2016

      Posted by Adeyinka Fagbamila -> BLTcEF on 5/28/2016 1:11 AM

    • Good job but you should have included all PTs not just doctorate or clinical specialists. We all need access to order the tests. The radiologist reads them and we relate the findings to our patient's symptoms which is what we have done for years.

      Posted by Bernie Blystone PT on 5/11/2017 3:39 PM

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