State of Direct Access to Physical Therapist Services

The American Physical Therapy Association (APTA) has released its 2025 report, State of Direct Access to Physical Therapist Services, highlighting the progress and ongoing challenges in enabling patients to access physical therapy without a physician’s referral.

Nationwide Access Achieved

As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have adopted either provisional or unrestricted direct access to physical therapist services. This milestone follows extensive advocacy by APTA and its members to eliminate outdated referral requirements in state laws. However, variations persist, with some states imposing limitations on the duration or number of visits without a referral.

Evidence Supporting Direct Access

The report consolidates research demonstrating that direct access to physical therapy is safe, effective, and cost-efficient. Studies indicate that patients who begin treatment directly with physical therapists experience:

• Reduced healthcare costs and fewer therapy sessions.

• Lower reliance on imaging, medications, and specialist referrals.
• Improved functional outcomes and higher patient satisfaction. For instance, a systematic review found that direct access led to significant cost savings and better outcomes for patients with musculoskeletal disorders.

Ongoing Challenges

Despite the legal framework supporting direct access, several barriers remain:

• Inconsistent state-level provisions that limit treatment without a referral.
• Insurance policies that require referrals or prior authorization for payment.
• Lack of public awareness about the availability and benefits of direct access.

These obstacles can delay care, increase costs, and hinder patient outcomes. apta.org

APTA’s Call to Action

APTA President Kyle Covington, PT, DPT, PhD, emphasizes the need for continued efforts to remove these barriers:

“Direct access to physical therapist services is well established as safe, effective, and essential to high-quality care. APTA calls on payers, regulators, and policymakers to remove the outdated and unnecessary barriers that still limit patient access to physical therapist services.

Utilizing the Report

The State of Direct Access report serves as a resource for policymakers, employers, and payers to:

• Understand the current landscape of direct access across the U.S.
• Implement strategies to improve patient access and reduce healthcare costs.
• Recognize the value of direct access in enhancing patient care.

APTA encourages stakeholders to use this report to advocate for policy changes and to educate the public about the benefits of direct access to physical therapy services.

For more information or to access the full report, visit APTA’s Direct Access Advocacy page. apta.org.

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