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More needs to be done to improve direct access in states across the country.
Improving direct access to physical therapist services has been a public policy priority for APTA for many years. As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment. Even though patients may go directly to a physical therapist without a referral, some provisions tied to treatment absent a referral still persist in a number of states — despite evidence that unrestricted direct access benefits patients, providers, employers, payers, and the U.S. health care system.
Why It Matters
Direct access restrictions cause unnecessary delays for people who would benefit from treatment by a PT. Delays in care result in higher costs, decreased functional outcomes, and frustration for patients seeking physical therapy treatment. Eliminating arbitrary barriers results in timely, more effective care.
Our Position
Allowing individuals to make decisions regarding their health care is good policy. Eliminating the referral requirement makes health care more accessible to more people. We must amend current statutes at the state level to remove arbitrary limitations on direct access to physical therapy services.
The State of Direct Access in the United States
To continue to improve patient access to care, APTA’s report, “State of Direct Access to Physical Therapist Services in the United States,” is intended to address common concerns raised during direct access advocacy and implementation negotiations.
Recommended Content
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.
Sep 4, 2024 / Resource
Review each jurisdiction’s level of direct access to physical therapist services.
Additional Direct Access Advocacy Content
May 24, 2024 / News
Recent changes in Alabama mean that all states now have either provisional or unrestricted access to physical therapy without a referral.
Jan 26, 2024 / News
A new report from DOD says that positioning PTs as primary care providers for neuromusculoskeletal conditions is "entirely feasible."
Nov 10, 2023 / Review
Patients who first sought care from a physical therapist or chiropractor had fewer opioid prescriptions and MRIs after diagnosis.
Jul 24, 2023 / Roundup
Growing participation in the PT Compact, expanded direct access, ability to order imaging, limits on prior authorization, and more.
Mar 1, 2023 / Roundup
It's looking like a busy year for state legislatures, with the potential for some good news for the profession. Now's your chance to help.
Feb 8, 2023 / News
The association's public policy priorities are aimed at unleashing physical therapy's potential to take on pressing health care challenges.
Aug 26, 2022 / Roundup
State advocates for the profession racked up some important wins this year. Here are highlights.
Jan 26, 2022 / Podcast
Topics covered include direct access, the physical therapy compact, telehealth, and more.
Aug 11, 2021 / Review
Research in the military health care system revealed lower costs and symptom recurrence for patients who saw a PT within 30 days.
Jul 26, 2021 / Roundup
From better insurer responsiveness to direct access improvements, to breakthroughs on PT use of imaging, lots of state-level achievements.