APTA Advocacy Win

After years of legislative and regulatory advocacy, CMS has finally changed the PTA supervision requirement to align with all other Medicare settings. In the 2025 Medicare physician Fee Schedule final rule, CMS changed the supervision requirement for physical therapist assistants from the burdensome direct supervision requirement to general supervision. This change will provide more flexibility for the therapy workforce and ensure access to therapy services for millions of Medicare beneficiaries, especially in rural or underserved areas. The language in the final rule mirrors the APTA-backed legislation introduced in the 118th Congress, the EMPOWER Act, which would have required CMS to make this long-advocated-for change.

The Issue

Medicare permits general supervision of physical therapist assistants by physical therapists in all settings — except for outpatient private practice under Part B, which requires direct supervision. Physical therapists and physical therapist assistants are governed by their state's practice act and must follow their state licensure requirements if they are more stringent than Medicare’s. However, 49 states permit "general supervision" of physical therapist assistants in outpatient practices, making Medicare’s direct supervision requirement in that setting more burdensome than most state licensure requirements.

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Why It Matters

PTAs play a crucial role in the PT-PTA team and help bridge the gap in access to care. Instead, the current direct supervision requirement makes it harder for this access to be provided and threatens physical therapy businesses, particularly in rural and underserved areas where beneficiaries are 50% more likely to receive therapy from a PTA. Enactment of the EMPOWER Act (H.R. 4878/S. 2459) would standardize the supervision requirement from direct to general for private practices, help ensure continued patient access to needed therapy services, and give practices more flexibility in meeting the needs of beneficiaries.

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