Direct Access in Practice

In 2009, APTA conducted a survey of physical therapist members in select chapters to determine (1) the extent to which direct access is being used and promoted by physical therapists, (2) the variation in its use in different practice settings and geographical locations, and (3) the reasons for the variation. In addition, respondents were asked to provide input on strategies that are being used to successfully implement direct access.

The survey results provide interesting data which will be useful in determining the types of resources and activities to help increase the use of direct access in physical therapist practice. This Executive Summary (.pdf) (members only) provides a condensed version of the survey results along with recommendations. For more detailed survey results, contact

APTA developed the following resources to promote the use of direct access in physical therapist practice. These resources are for physical therapists in states in which some level of direct access is allowed by state law. Physical therapists should be able to use these resources in clinical settings and with patient populations where direct access is not restricted by state or federal regulations, employer restrictions, payer, or compliance requirements.

Podcast & Videos

Podcast: Improving Access to Care for Medicare Patients  - 8/8/12 Members Only Icon

Video: Direct Access Models of Care Webinar - 6/14/12 Members Only Icon

Podcast: Direct Access in Practice - 6/24/10 Members Only Icon

Direct Access in Hospital-Based Settings

Allowing patients to have direct access to physical therapist services in hospital-based outpatient settings has become a priority for many physical therapists. The process for implementing this change is specific to each setting but often depends upon the relationships between the physical therapist and both the hospital administration and the medical community.

Additionally, there are specific Medicare regulations that dictate how order for rehabilitation must be handled in hospitals that participate in the Medicare program. These regulations apply to all patients receiving rehabilitation services in Medicare certified hospitals, including non-Medicare beneficiaries. A resource is available which provides an explanation of this regulation and suggestions for compliance.

Direct Access in Hospital-Based Outpatient Settings Members Only Icon Updated Icon

Audio Course: Hospital Based Direct Access

Direct Access and Medicare

Medicare beneficiaries are able to go directly to physical therapists (PT) without a referral or a visit to a physician. Learn more on Direct Access and Medicare.

Preparing for Direct Access in Your Practice Setting

APTA has prepared several resources to help physical therapists successfully integrate direct access into clinical practice.

Direct Access Checklist for Clinicians (.pdf) Members Only Icon
Helps physical therapists overcome potential barriers to direct access and addresses issues of clinical preparation, referral relationships, payment, and marketing.

Direct Access Checklist for Managers, Practice Owners, and Administrators (.pdf) Members Only Icon
Helps managers, owners, and administrators consider both challenges and opportunities in the implementation of direct access.

Direct Access: A Resource for Implementation (.pdf) Members Only Icon
Provides a road map that should be useful both clinicians and to practices interested in making physical therapist services available to the public without referral.

Implementing Direct Access in Physical Therapy Practice: A PT 2012 Panel Presentation
This online course will discuss findings from the 2009 APTA Direct Access in Practice survey, including the extent to which direct access in being used and the barriers and perceived barriers to its use in different settings and geographic locations.

Payment for Physical Therapist Services with Direct Access

Managed care contracts and insurance companies often have no requirements for a referral for physical therapy. Check your contract or payer policy to be sure. Many insurance companies now recognize the cost savings and improved access to care that come with direct access and do not require a referral for payment. Don't assume that there is a referral requirement unless you know for sure. If you have questions about payment for physical therapist services provided without referral, or if you are able to share information about payment for services in your region or clinical setting, contact

Marketing Resources for Direct Access

As a part of the new branding initiative, APTA has developed public relations and marketing resources to help physical therapists market directly to consumers and other potential sources of patient/client referrals, including patient handouts. Be sure to download the "Choosing Your Physical Therapist" handout to leave in your waiting room.

One of the goals of APTA's "Move Forward" branding initiative is to promote the profession of physical therapy to the outside community with important messages regarding the role of the physical therapist in improving movement. For more information on the branding campaign, visit BrandBeat.

Research Supporting Direct Access

There is a growing body of research to support the use of direct access in physical therapy. This section includes articles and other sources of data on this topic.

Physical Therapy Direct Access Article Collection

Health Services Research Direct Access Study Toolkit

Advocacy for Direct Access

Direct Access at the State Level
Provides information on laws or advocacy efforts related to direct access at the state level. You will find valuable information about obtaining direct access in your state; links to your state practice act and regulations; arguments in support of direct access; and several helpful resources and articles related to cost effectiveness, and safety. Information on these pages will help you advocate for direct access in both clinical settings and legislative arenas.

Direct Access at the Federal Level
Provides information on direct access at the federal (Medicare) level.

Additional Resources

International Summit on Direct Access and Advanced Scope of Practice
In October 2009, APTA led a conference that investigated advanced models of physical therapist practice both in the United States and internationally. The event was co-sponsored by the APTA, the Canadian Physiotherapy Association (CPA), and the World Confederation of Physical therapy (WCPT) and included participants from more than 20 countries.

Conference speakers presented research, best practice models for direct access and advanced/extended scope of practice, and international perspectives on policy and leadership in physical therapy. A compendium of resources from the International summit which includes speaker presentations is available at the conference website.

Direct Results Around the World Members Only Icon
Think direct access and advancing scope of practice are essentially American issues? Think again.
PT in Motion - June 2011

Direct Access: How It Can Change Your Practice!
This article was written to help dispel myths and encourage use of direct access in practice. It has been published in several chapter newsletters across the country.

Direct Access: Exploring New Opportunities Members Only Icon
This article provides ideas on how to use direct access in different practice settings.
PT— Magazine - February 2002

Guide to PT PracticeSocious - Hubba Hubba