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 3: Referral Not Required for Physical Therapy Prevention

Subdivision (c) of section 6731 of the Education Law provides that physical therapy treatment must be rendered pursuant to a referral, unless the physical therapist (PT) meets the qualifications set out in section 6731(d). If the PT meets those qualifications, then treatment may be provided for 10 visits or 30 days, whichever comes first (see Practice Alert 1). PTs may engage in the evaluation or prevention of disability, injury, disease, or other condition of health, without the need for a referral from a physician, dentist, podiatrist, or nurse practitioner.

Physical therapy prevention consists of interventions that provide instruction in self-help skills to individuals or groups to prevent pathology or impairments from progressing into functional limitations or disability and to promote health, wellness, and fitness.

  1. Examples of physical therapy prevention screening and activities include:
    • identification of the elderly who are at risks for falls
    • identification of children who may need an examination for scoliosis
    • identification of children who may have a developmental delay

  2. Physical therapy prevention that promotes general health (performance or conditioning) in well individuals, may include:
    • evaluation of movement with suggestions that modify movement patterns to enhance performance
    • classes for the well elderly to enhance/maintain balance skills and coordination
    • pre- and post-partum classes to teach relaxation and maintain muscle tone and strength.

  3. Physical therapy activities that prevent or minimize the potential of the occurrence or reoccurrence of injury would include:
    • post-acute evaluation of movement with suggestions to modify movement patterns to reduce the risk of future injury
    • exercises for stretching or strengthening to prevent back problems in the absence of acute or recent pathology
    • workplace evaluation, exercises for stretching, strengthening, endurance and postural training to prevent job-related disabilities

  4. Physical therapy activities that limit the degree of disability in individuals with chronic or irreversible diseases may include:
    • aquatic exercise programs, including cardiovascular conditioning and resistive exercise, to maintain flexibility and fitness in individuals with chronic disorders

When providing preventive care, the PT or physical therapist assistant (PTA) must maintain a record that appropriately documents the activities undertaken with each patient/client.

If the physical therapy service is advertised as beneficial for the alleviation of an existing disability, injury or disease entity, or is billed to an insurer as a physical therapy treatment, it cannot simultaneously be termed prevention.

The PTA who participates in the prevention portion of physical therapy intervention is governed by the requirements for supervision by a licensed PT.

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Citations of Pertinent Law, Rules or Regulations:
Education Law, Section 6509 – definition of professional misconduct
Education Law, Section 6731 – definition of practice of physical therapy
Education Law, Section 6738 – definition of physical therapist assistant
Regents Rules, Part 29.1(b)(10) – delegation of professional responsibilities
Regents Rules, Part 29.1(b)(9) – accepting professional responsibilities
Regulations of the Commissioner, section 77.6 – supervision of PTA
Last Updated: August 11, 2016