Tenn. Comp. R. & Regs. 1150-01-.02 - SCOPE OF PRACTICE AND SUPERVISION

(1) Scope of Practice

(a) The scope of practice of physical therapy must be under the written or oral referral of a licensed doctor of medicine, chiropractic, dentistry, podiatry, osteopathy, nurse practitioner, or physician assistant, with the following exceptions, as provided in T.C.A. § 63-13-303.

1. A licensed physical therapist may conduct an initial patient visit without the referral of a referring practitioner;

2. A licensed physical therapist may provide physical assessments or instructions, including a recommendation of exercise to an asymptomatic person, without the referral of a referring practitioner.

3. In emergency circumstances, including minor emergencies, a licensed physical therapist may provide assistance to a person to the best of a physical therapist's ability without the referral of a referring practitioner. The physical therapist shall refer the person to the appropriate healthcare practitioner after providing assistance, with the exception of paragraph four (4) below.

4. A licensed physical therapist may treat a patient without a referral, within the scope of practice of physical therapy, when the following are met:

(i) The patient's physician, as defined in § 63-6-204(f)(7), has been notified by the physical therapist;

(ii) If the physical therapist determines, based on clinical evidence, that no progress has been made with respect to that patient's condition within thirty (30) days immediately following the date of the patient's initial visit with the physical therapist, then the physical therapist should cease providing additional physical therapy services and refer the patient to a healthcare practitioner who qualifies as a referring practitioner;

(iii) The physical therapist does not continue physical therapy services for the patient beyond ninety (90) days without consulting with the patient's appropriate healthcare practitioner;

(iv) If the patient was previously diagnosed by a licensed physician with chronic, neuromuscular, or developmental conditions, and the evaluation, treatment, or services are being provided for problems or symptoms associated with one (1) or more of those previously diagnosed conditions, then 4.(ii) and 4.(iii) do not apply; and

(v) A physical therapist refers patients under the physical therapist's care to appropriate healthcare practitioners, if, at any time, the physical therapist has reasonable cause to believe symptoms or conditions are present that require services beyond the scope of practice of a physical therapist, reasonable therapeutic progress is not being achieved for the patient, or physical therapy treatment is contraindicated.

5. For the purposes of this part of this rule, emergency circumstances means instances where emergency medical care is required. Notified means to give notice to or inform a patient's physician, as defined in § 63-6-204(f)(7), when a licensed physical therapist treats a patient pursuant to part 4. Emergency medical care means bona fide emergency services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:

(i) Placing the patient's health in serious jeopardy;

(ii) Serious impairment to bodily functions; or

(iii) Serious dysfunction of any bodily organ or part.

(b) Practice of Physical Therapy

1. Examining, evaluating and testing individuals with mechanical physiological and developmental impairments, functional limitations, and disability or other health and movement-related conditions in order to determine a physical therapy treatment diagnosis, prognosis, a plan of therapeutic intervention, and to assess the ongoing effect of intervention; and

2. Alleviating impairments and functional limitations by designing, implementing, and modifying therapeutic interventions that include, but are not limited to: therapeutic exercise; functional training; manual therapy; therapeutic massage; assistive and adaptive orthotic, prosthetic, protective and supportive equipment; airway clearance techniques; debridement and wound care, physical agents or modalities, dry needling, mechanical and electrotherapeutic modalities including patient-related instruction and electrophysiologic studies (motor and sensory nerve conduction, and somatosensory evoked potentials).

(i) Invasive kinesiologic electromyography may be performed only in a university academic setting as part of a research project that has been approved by the educational institution's Internal Review Board without a referral or;

(ii) Notwithstanding the provisions of subpart (i), diagnostic electromyography must be performed by a licensed physical therapist who has complied with the requirements of paragraph 1150-01-.04(4) and;

(iii) Notwithstanding the provisions of subpart (i), diagnostic and invasive electromyography may only be performed when there is a referral for such service from:

(I) An allopathic physician licensed under T.C.A. §§ 63-6; or

(II) An osteopathic physician licensed under T.C.A. §§ 63-9; or

(III) A doctor of dentistry licensed under T.C.A. §§ 63-5; or

(IV) A doctor of podiatry licensed under T.C.A. §§ 63-3; or

(V) A nurse practitioner licensed under T.C.A. §§ 63-7; or

(VI) Physician assistant pursuant to Tenn. Code Ann. §§ 63-19; and

3. Reducing the risk of injury, impairments, functional limitation and disability, including the promotion and maintenance of fitness, health and quality of life in all age populations; and

4. Engaging in administration, consultation, education and research; and

5. Manual Therapy Techniques - Consist of a broad group of passive interventions in which physical therapists use their hands to administer skilled movements designed to modulate pain; increase joint range of motion; reduce or eliminate soft tissue swelling, inflammation, or restriction; induce relaxation; improve contractile and noncontractile tissue extensibility; and improve pulmonary functions. These interventions involve a variety of techniques, such as the application of graded forces, which are not performed beyond the joint's normal range of motion. These interventions may be applied to all joints of the body as deemed appropriate.

(c) Substandard Care

1. Overutilization of appropriate physical therapy services or the lack thereof.

2. Providing treatment intervention that is unwarranted by the condition of the patient.

3. Providing treatment that is beyond the point of reasonable benefit.

4. Abandoning the care of a patient without informing the patient of further care options.

5. Failing to practice in accordance with the standards set forth in the "Guide to Physical Therapist Practice," pursuant to Rule 1150-01-.02(1)(f).

(d) "Physical therapy" or "physiotherapy" are identical and interchangeable terms. "Practice of physical therapy" and "physical therapy assistive personnel" are defined in Rule 1150-01-.01.

(e) Nothing in this rule shall be construed as authorizing a physical therapist, or physical therapist assistant, or any other person to practice medicine, chiropractic, osteopathy, podiatry, nursing, or practice as a physician assistant.

(f) The Board adopts, as if fully set out herein, and as it may from time to time be amended, the current "Guide to Physical Therapist Practice" issued by the APTA. Information to acquire a copy may be obtained by contacting the:

American Physical Therapy Association

1111 North Fairfax Street

Alexandria, VA 22314-1488

Telephone: (703) 684-2782

Telephone: (800) 999-2782

Fax: (703) 684-7343

T.D.D: (703) 683-6748 Internet: www.apta.org

(g) Universal Precautions for the Prevention of Transmission of Human Immunodeficiency Virus (HIV) - The Board adopts, inclusive of any guidelines of the Department of Health, the Guidelines for the Standard Precautions (Guidelines published by the Centers for Disease Control and Prevention (CDC) that can be found in The Healthcare Infection Control Practices Advisory Committee 2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007 Dec;35(10 Suppl 2):S65-164, https://doi.org/10.1016/j.ajic.2007.10.007 and any amendments made by the CDC to the Guideline.

(2) Supervision.

(a) Supervision of licensed physical therapist assistants - Supervision, as applied to the licensed physical therapist assistant, means that all services must be performed under the supervision of a physical therapist licensed and practicing in Tennessee. Guidance for the rendering of such services is as follows:

1. The licensed physical therapist shall perform the initial evaluation of the patient with the development of a written treatment plan, including therapeutic goals, frequency and time period of services.

2. The licensed physical therapist shall perform and document re-evaluations, assessments, and modifications in the treatment plan at least every thirty (30) days. For patients seen longer than sixty (60) days, the licensed physical therapist shall inspect the actual act of therapy services rendered at least every sixty (60) days.

3. The licensed physical therapist may not supervise a physical therapist assistant that is delivering services at a site further than sixty (60) miles or one (1) hour from the licensed physical therapist. The supervising licensed physical therapist must be available to communicate by telephone or other means whenever the physical therapist assistant is delivering services.

4. The discharge evaluation must be performed and the resulting discharge summary must be written by the licensed physical therapist.

5. The licensed physical therapist and the physical therapist assistant shall be equally responsible and accountable for carrying out the provisions of this subparagraph.

(b) Supervision of physical therapy assistive personnel (See Rule 1150-01-.01).

1. A physical therapist may use physical therapy aides for designated tasks that do not require clinical decision making by the licensed physical therapist or clinical problem solving by the licensed physical therapist assistant. Direct supervision must apply to physical therapy aides and is interpreted to mean that services are provided under the supervision of an on-site physical therapist or physical therapist assistant licensed and practicing in Tennessee.

2. A physical therapist may use other assistive personnel for selected physical therapy designated tasks consistent with the training, education, or regulatory authority of such personnel. Other assistive personnel (nationally certified exercise physiologists or certified athletic trainer and massage therapists, etc.) must perform the delegated task under the on-site supervision of a physical therapist. The physical therapist shall then co-sign all related documentation in the patient records.

3. "On-site supervision" means the supervising physical therapist or physical therapist assistant must:

(i) Be continuously on-site and present in the department or facility where assistive personnel are performing services; and

(ii) Be immediately available to assist the person being supervised in the services being performed; and

(iii) Maintain continued involvement in appropriate aspects of each treatment session in which a component of treatment is delegated to assistive personnel.

(c) A physical therapist may concurrently supervise no more than the equivalent of three (3) full-time physical therapist assistants. A physical therapist may concurrently supervise no more than the equivalent of two (2) full-time assistive personnel or physical therapy aides.

(d) Pursuant to Rule 1150-01-.01, physical therapists and physical therapist assistants shall provide direct onsite supervision of volunteers. Volunteers may not provide physical therapy to patients.

(e) A physical therapist shall provide on-site supervision, as defined in part (b)3. of paragraph (2) of this rule, to physical therapy clinical students at all times, and will be in accordance with the APTA guidelines for clinical education which suggest a minimum of one (1) year of licensed clinical experience prior to functioning as a clinical instructor for physical therapist students.

(f) A physical therapist assistant shall provide on-site supervision, as defined in part (b)3. of paragraph (2) of this rule, to physical therapist assistant clinical students at all times, and will be in accordance with the APTA guidelines for clinical education which suggest a minimum of one (1) year of licensed clinical experience prior to functioning as a clinical instructor for physical therapist assistant students.

Notes

Tenn. Comp. R. & Regs. 1150-01-.02

Original rule filed June 6, 1978; effective July 6, 1978. Amendment filed September 29, 1981; effective December 29, 1981. Repeal and new rule filed September 30, 1987; effective November 14, 1987. Amendment filed March 26, 1991; effective May 10, 1991. Repeal and new rule filed February 21, 1996; effective May 6, 1996. Repeal and new rule filed March 16, 2000; effective May 30, 2000. Amendment filed January 23, 2002; effective April 8, 2002. Amendment filed April 8, 2003; effective June 22, 2003. Amendment filed September 22, 2005; effective December 6, 2005. References to Board of Occupational and Physical Therapy Examiners have been changed by the Secretary of State to the applicable entity; Board of Occupational Therapy and/or Board of Physical Therapy pursuant to Public Chapter 115 of the 2007 session of the Tennessee General Assembly. Amendment filed September 24, 2009; effective December 23, 2009. Amendments filed August 19, 2010; effective November 17, 2010. Emergency rule filed April 10, 2024; effective through October 7, 2024. Emergency rule expired effective October 8, 2024, and the rule reverted to its previous status. Amendments filed February 4, 2025; effective 5/5/2025.

Authority: T.C.A. §§ 63-13-102, 63-13-103, 63-13-104, 63-13-301 through 63-13-304, and 63-13-311.