Physical Therapy. FAQs from the Executive Council of PTOT
Written by Editor   
Tuesday, February 05, 2019 12:50 PM

The PT Practice Act states that Physical therapy means a form of health care that prevents, identifies, corrects, or alleviates acute or prolonged movement dysfunction or pain of anatomic or physiologic origin.”

It further notes that “the board may deny a license or suspend or revoke a license, place a license holder on probation, reprimand a license holder, impose an administrative penalty, or otherwise discipline a license holder if the applicant or license holder has: (1) except as provided by Section 453.301 or 453.302,provided physical therapy to a person without a referral from a referring practitioner” (emphasis added).

The act notes that “referring practitioner means a qualified licensed health care professional who, within the scope of professional licensure, may refer a person for health care services. The term includes:(A) a physician …(B) a dentist… (C)  a  chiropractor…and (D) a podiatrist….”

At their website the the PTOT has a FAQ page.  Some of the more interesting answers to their frequently asked questions include:

What is within the scope of practice of a PT or PTA in a home health setting?

The Board does not differentiate between types of settings, as far as the scope of practice is concerned. The scope of practice as defined in Section 453.005 of the Practice Act is not all inclusive. While the Board will define those activities which may be physical therapy, it leaves those activities which are not defined as physical therapy (but which may be associated services) to the discretion of the provider/licensee. The Board recommends that a PT or PTA use professional judgment to decide in which areas they are proficient, based on the training they have received.

What techniques/procedures are not allowed to be performed by a PTA?

The Texas PT Practice Act/rules do not prohibit a PTA from performing any specific technique/procedure.

The supervising PT holds the primary responsibility for all physical therapy care rendered under his/her supervision, and is responsible for assuring that a PTA has the competencies required to perform a technique or procedure that is delegated. Consideration should be given to the PTA’s level of skill/training and experience/advanced competency, the practice setting in which the procedure is performed, the type of monitoring that might be needed, and the acuity and complexity of the patient’s condition. Additionally, the PT should personally possess the skills in order to supervise the PTA.

It would be a violation of the PT Practice Act/Rules for a PT to delegate a technique or procedure to a PTA who is not competent to perform it, and it would be a violation of the PT Practice Act/Rules for a PTA to perform or attempt to perform techniques or procedures for which they are not competent.

It is recommended that the rules and regulations of payer sources, i.e. Medicare/Medicaid or private insurance, be reviewed to determine if a specific technique/procedure is reimbursable if performed by a PTA as they can differ from the licensure rules/regs.

Is there a limit on how long a referral is valid?

There is NO specific length of time a referral is valid or good; the Board leaves it to the professional judgment of the PT to determine whether the referral is valid. If you have doubts, you should contact the referral source, as the Board has no rules addressing this question.

When does a referral expire?

The Board does not set a time limit on referrals for initial treatment.  If you are concerned for any reason about how long it has been since the referral was made, you should consult with the referring practitioner before beginning treatment. There are time limits and requirements for treating patients who have had a prior referral for the same condition. See the Board rules, §322.1(a)

Who can write an order for treatment?

You may accept an order from any practitioner authorized by law to prescribe treatment. This includes PAs and Advanced Practice Nurses of all types (midwives, clinical specialists, FNPs, for example.) The referring practitioner must be licensed or authorized to practice, but not necessarily by a Texas Board.

Can a PT accept a referral from a physician outside the US?

Yes. The Board amended §321.1, Provision of Services, several years ago to allow a PT to accept a referral from a "qualified healthcare practitioner licensed by the appropriate licensing board." The PT accepting the referral is responsible for ensuring that the practitioner is legally able to practice in that country, and legally authorized to write a referral for treatment in that country. This is no different than what is required if you accept a referral from a source in the U.S., but it does leave it up to the PT to determine the country’s requirements. See the Board rules, §322.1(a).

How long must I keep medical records?

The Physical Therapy Practice Act does not give the Board specific authority to address record retention. The Board recommends that a PT either consult with an attorney for professional legal advice, or use the Medical Board’s record retention rules as guidelines. Those rules are found in Rule 165.1(b), and can be accessed at

What can I charge for medical records?

The PT Board has no rules regarding medical records, including what PTs may or may not charge for them. If you have questions concerning your legal rights and responsibilities regarding medical records, you are advised to consult with an attorney. If you are looking for an example of what other professionals charge for medical records, you will find the guidelines set out by the Texas State Board of Medical Examiners.