In the United States, PTs can supervise up to 4 PTAs at the same time, but may not supervise more than 3 of a mixed group of aides, physical therapist students, physical therapist assistant students, and/or temporary licensees. Physical therapist assistants are known to provide physical therapy services under the supervision and instruction of a physical therapist.

PTAs primarily are allowed to implement components of patient care, input data related to the treatments offered, and align with the PT to adjust care if need be. They also help the physical therapist in the treatment of patients of all ages, from newborns to people at the end of life.  PTAs may also help to cater to people who merely want to become healthier and to prevent future problems.

However, in the United States, you have to understand that a physical therapist is in charge of all services provided by the PTA. A PT is expected to analyse and examine each individual and create a treatment plan to boost their ability to move, reduce or manage pain, restore function, and prevent disability.

PTAs can have a significant impact on people’s lives, but they are only allowed to help these people reach their fitness goals, regain or maintain their independence, and lead active lives. However, it is solely the duty of the physical therapist (PT) alone to evaluate and assess patients, develop a plan of care, and oversee provision of services.

PTAs and physical therapy students play very crucial roles in carrying out the plan of care, but there are supervision rules that guide their duties and inputs. These rules are designed to ensure that patients and clients are always getting the safest and most effective care.

These supervision requirements for physical therapist assistants (PTAs) and physical therapy students (both physical therapist and PTA students) vary based on some factors, such as the policies of individual payers and insurers, state practice act provisions, and the setting in which physical therapy is being provided.

Factors that Influence Supervision Requirements for PTAs and Physical Therapy Students

To understand the required level of supervision of PTAs and students, here are factors to consider;

  1. State Practice Laws

Note that state practice laws more or less explain the extent of the practice of PTs and the range of work of PTAs and physical therapy students. However, it still remains the primary duty of the PTs to document, therefore, for dictating supervision requirements.

Have it in mind that not all state practice laws explicitly state supervision of either PTAs or physical therapy students, although some laws address PTAs but not students. Nonetheless, here are options to consider in such situations:

  • If the state practice law doesn’t cover the level of supervision of students but does contain policies on PTA supervision, then apply the rules of PTA supervision to physical therapy students.
  • If the state practice law fails to explicitly address both supervision of PTAs and the supervision of physical therapy students, then consider the supervision requirements of the payer policy. For instance, if the individual who is getting the services has health insurance from Blue Cross, then you should consider seeking directions from that company’s policies regarding supervision of PTAs and students. If the person is a Medicare or Medicaid patient, check that agency’s billing policy.
  1. Medicare Provisions

Once the state practice law fails to address supervision requirements, you should consider Medicare’s billing guidelines to understand the required level of supervision for PTAs and students in rendering services to Medicare beneficiaries. Note that Medicare stipulates general supervision of PTAs in all settings other than private practice, in which direct supervision is required.

Medicare also dictates extra requirements even under general supervision. For example, when a PTA renders services to a patient in a detached clinic (explained by Medicare as “a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients”), rehabilitation agency, or public health agency, the supervising PT is expected to make an onsite visit at least once every 30 days.

In addition, Medicare notes that PTs are not permitted to charge for services rendered by physical therapy students, especially since they are not licensed practitioners. However, students may assist PTs in rendering billed services, and PTs may physically guide students through the provision of a billed service. But they are expected to use their profundity in such situations. Nevertheless, Medicare offers these situations as detailed recommendations for appropriately billing Part B services:

  • The PT is physically available and in the room for the whole period. The student joins in the rendering of services only when the PT is directing the service, exercising expertise, and is the party in charge of analysis and treatment of the patient or client.
  • The PT is physically available in the room, directing the student in service delivery whenever the student is participating in its provision. The PT is never directly involved in treating other patients or performing any other tasks.

Always remember that the PT is the person in charge and, therefore, signs all documentation. (A physical therapy student also may sign, but the student’s signature is unnecessary.) PTAs and physical therapy students are not allowed to bill for their services under Medicare or any other payer. The supervising PT, instead, will have to bill for all services under his or her National Provider Identifier issued by the Centers for Medicare and Medicaid Services.

In terms of every services rendered by PTAs: Medicare and commercial insurers presently are known to reimburse for services provided by PTAs at the same rate as they do those rendered by PTs. Starting from 2022 every duty and service rendered by PTAs will be reimbursed at 85% of the Medicare physician fee schedule rate that appeals to those rendered by PTs.

  1. Commercial Insurers

Also note that PTs seeing to the needs patients or clients whose health care is covered by a commercial insurance plan are expected to extensively read the contract with the insurer to make sure that they meet supervision policies covering PTAs and students. Commercial insurers are known to defer to Medicare guidelines, but it is vital and recommended to check with the insurer to be certain.