Practice Alerts

Laws, rules and regulations, not Alerts, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to this Alert may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations, some citations of which are listed at the end of this Alert.

Alert 14: Practice of Alternative and Complementary Therapies by a Physical Therapist or Physical Therapist Assistant

Increasingly, consumers are seeking complementary and alternative therapies to treat health conditions from arthritis to zinc deficiency. Many complementary and alternative therapies can be performed by the lay public and do not require that the practitioner be licensed by a government entity, such as the Education Department. A licensed professional, including a physical therapist (PT) or physical therapist assistant (PTA), may obtain certification in complementary and alternative therapies.

The National Center for Complementary and Alternative Medicine (NCCAM), within the National Institutes of Health, defines complementary and alternative therapies as healthcare practices not currently an integral part of conventional medicine. Complementary therapies, such as aromatherapy, are used together with conventional treatments. Alternative therapies are used in place of conventional practices, such as using a special diet to treat cancer instead of undergoing surgery, radiation or chemotherapy. Complementary and alternative therapies are grouped into five major domains:

  1. alternative systems built upon complete systems of theory and practice, such as homeopathy and Ayurveda;
  2. mind-body interventions to enhance the mind's ability to affect bodily function, such as prayer or meditation and creative outlets such as art or dance therapy;
  3. biologically based treatments with naturally occurring substances like dietary supplements or herbal products;
  4. manipulative and body-based methods for manipulating or moving one or more parts of the body; and
  5. energy therapies to either affect the energy fields that purportedly surround or penetrate the human body, such as qi gong, Reiki and therapeutic touch.

Some of the techniques utilized in these domains have been incorporated into the practice of physical therapy and other professions. This does not imply that an individual licensed in a health profession is qualified to practice another profession, such as medicine.

Article 131 of New York State Education Law defines the practice of medicine as: "diagnosing, treating, operating or prescribing for any human disease, pain, injury, deformity or physical condition" (Section 6521) and restricts the practice of medicine to those licensed or authorized by law. The practice of medicine is not limited to what would be considered Western allopathic medicine and is broad enough to encompass treatments not recognized at the time the statute was written1. Nothing should be construed to suggest that a licensed or unlicensed practitioner is authorized to practice medicine or another licensed profession (e.g., acupuncture, dietetics, or chiropractic), unless that individual is specifically authorized to do so or exempt under the Education Law.

Whenever a PT uses alternative or complementary therapies that are within the scope of PT practice, he or she is practicing as a PT and all New York State laws and regulations regarding the practice of physical therapy are in effect. For example:

  • When necessary, a referral for physical therapy treatment must be obtained from a qualified provider unless the PT is qualified to provide treatment under direct access.
  • If the services are of a prevention or wellness nature, no referral is needed.
  • Physical therapy evaluations may lawfully be performed only by the PT.
  • A qualified PTA may perform appropriate complementary and alternative therapies as directed by the supervising PT, provided that the PTA is competent to perform them.
  • Billing for physical therapy services must follow procedures outlined by the payer and applicable state laws and regulations.

Alleged violations of Education Law and the applicable rules and regulations related to the practice of physical therapy by a licensee using alternative therapies could result in charges of unprofessional conduct.

If a licensed PT uses alternative therapies that are outside the scope of practice of physical therapy (e.g. herbs), he or she may not hold such therapies out to be physical therapy services. The provision of such alternative therapies must be completely separate from the provision of physical therapy services. Accordingly, they may not be provided through the licensee's physical therapy practice, and they may not be associated in any way with that practice or with the fact that the provider holds a physical therapy license. When a PT or a PTA is performing alternative therapies outside of a physical therapy practice, he or she may do what a non-licensed person can do, but may not hold him or herself out to be a licensee.

Services that are outside the scope of physical therapy may not be billed as physical therapy services. Patients/clients should be provided with clear information about the services being provided. Effective communication by the practitioner and informed consent from the consumer are essential to minimize complaints about practice and confusion about billing practices and policies. Any advertising or statements that his or her alternative services are superior due to physical therapy or physical therapist assistant education or experience could subject the individual to charges of professional misconduct.

1 People v. Amber, 1973, 76 Misc.2d 267, 349 N.Y.S.2d 604.

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Citations of Pertinent Law, Rules or Regulations:
Education Law, Section 6738 – definition of practice, physical therapy and physical therapist assistant
Education Law, Section 6521 – definition of practice, medicine
Regents Rules, Part 29 – professional misconduct
Last Updated: August 11, 2016