Primary Care Recognition

• Utah: PTs are now legally recognized as potential primary care providers for neuromusculoskeletal conditions, allowing patients to choose PTs directly under certain health plans.

Workers’ Compensation

• Montana: PTs are now included in the definition of “treating physician,” improving direct access and payment for services in workers’ compensation cases.

Provider Credentialing

• Wyoming: Insurers must complete PT provider credentialing within 60 days and follow set procedural guidelines.

Direct Access Improvements

• Oklahoma: PTs under direct-to-employer contracts can treat patients up to 30 days without referral (starting Nov. 1).
• Texas: Expanded direct access treatment time from 10 to 30 days.

 

Medicaid Access & Payment

• North Carolina: Medicaid now covers PT services at private practices for patients 21+.
  
• Massachusetts: Medicaid reimbursement rates for common PT codes increased up to 78%.
  
• Arkansas: Medicaid must reimburse clinic-based PT services.
  
• Colorado:
  
• Defeated proposed Multiple Procedure Payment Reduction.
  
• Secured 1.6% rate increase.
• Prevented excessive plan-of-care signature requirements beyond CMS standards.

 

Prior Authorization Reform

• Indiana:
• No PA required for first 12 PT visits of new care episode.
• Cannot deny claims solely because a referring provider is out-of-network.
• Oregon:
• Insurers must publish PA data.
• Must use API to let providers check if PA is required and what documentation is needed.

 

Fair Copays

• Ohio:
• PT copays can’t exceed those for primary care visits.
• Health plan issuers must clearly post PT coverage details.

 

Title Protection

• Virginia: Only licensed PTs may use “DPT” or “doctor of physical therapy.”

 

PTA Supervision Flexibility

• Louisiana, Montana, South Dakota: Reduced frequency of mandatory supervising PT visits.
• New York: Passed legislation to move from direct to general PTA supervision (awaiting governor’s action).

 

Disability Placard Certification

• Arizona, Arkansas, Nevada, Wyoming: PTs can now certify disability placard applications.

 

Diagnostic Imaging Privileges

• Arizona: PTs can now order all necessary imaging for existing patients.
• North Dakota: Expanded from plain films to full musculoskeletal imaging.
• Rhode Island: PTs’ imaging order privileges extended indefinitely.

Workforce Expansion

• Nevada:
• PTs eligible for Student Loan Repayment in underserved areas.
• Joined PT Interstate Compact (39th state).

Student Athlete Concussions

• North Carolina: PTs added to school concussion protocol for evaluation and return-to-play clearance.

 

Telehealth

• New Jersey: Extended telehealth pay parity for PT through July 1, 2026.