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More needs to be done to improve direct access in states across the country.

Direct access means the removal of the physician referral mandated by state law to access physical therapist services for evaluation and treatment. Every state, the District of Columbia, and the US Virgin Islands allow for evaluation and some form of treatment without physician referral. However, many of those states continue to impose arbitrary restrictions on direct access, or only allow for treatment without referral under very limited circumstances.

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 to 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.


Recommended Content

Improving Direct Access at the State Level

Feb 12, 2020 / Article

Direct Access By State

Sep 6, 2023 / Resource


Additional Direct Access Advocacy Content

APTA Advocacy Win: Defense Dept. to Roll Out System-Wide Direct Access to PTs

Jan 26, 2024 / News

A new report from DOD says that positioning PTs as primary care providers for neuromusculoskeletal conditions is "entirely feasible."

From PTJ: Seeing PT or Chiropractor First for Low Back Pain Is Less Costly

Nov 10, 2023 / Review

Patients who first sought care from a physical therapist or chiropractor had fewer opioid prescriptions and MRIs after diagnosis.

APTA Chapters Fuel State-Level Wins

Jul 24, 2023 / Roundup

Growing participation in the PT Compact, expanded direct access, ability to order imaging, limits on prior authorization, and more.

State Legislative Update, 2023: PT Compact, Improved Direct Access, 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.

APTA's Advocacy Road Map: Empowerment for the Profession, Results for Patients

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.

APTA 2022 State Legislation Roundup: Prior Authorization, Telehealth, and More

Aug 26, 2022 / Roundup

State advocates for the profession racked up some important wins this year. Here are highlights.

Statehouse Roundup: Hot Advocacy Issues at the State Level

Jan 26, 2022 /

Topics covered include direct access, the physical therapy compact, telehealth, and more.

Study: Early Physical Therapy Provides a Leg Up on Knee Pain

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.

APTA 2021 Statehouse Roundup: New Prepayment Review Law, Imaging Wins, More

Jul 26, 2021 / Roundup

From better insurer responsiveness to direct access improvements, to breakthroughs on PT use of imaging, lots of state-level achievements.

State Legislative Advocacy: ND Imaging Win, Compact Growth, and More

Apr 16, 2021 / Roundup

Many state legislatures are still in session, but positive changes are already in the works. Here's a progress report.