Can a Physical Therapist Order X-Rays or an MRI? The Rules in Every State

In most states the rules don't say. Nine jurisdictions let a physical therapist order imaging in a statute or rule: Arizona, Colorado, DC, Iowa, New Mexico, North Dakota, Rhode Island, Utah and Wisconsin. Where it's allowed, the common conditions are a doctorate or extra training, a radiologist or physician reading the study, and a duty to send the results to the patient's doctor within a set time. Four more have a board statement or rules that point to yes. Three say no, two leave it to an X-ray rule that doesn't list PTs, and in 33 the PT rules have nothing specific on ordering.

This article goes through every state for physical therapists: whether the practice act or rules allow, bar or leave out ordering imaging, the conditions where it's allowed, and the exact words of each rule with a link to the official source. Then it covers Medicare, because what your state allows and what a payer will cover are separate questions. I'm an occupational therapist, not a PT, so I've stayed with what the rules say.

This isn't legal advice. I checked every rule on November 9, 2026, on the state's own legislature, code or board site. Your board's current rule is the one that counts.

The Short Answer

• Yes, in a statute or rule: 9. Arizona, Colorado, DC, Iowa, New Mexico, North Dakota, Rhode Island, Utah and Wisconsin.
  • Imaging without naming a type in 5: Arizona, Colorado, DC, North Dakota and Utah. Iowa names plain radiographs and MRI. New Mexico names X-ray, MRI and CT. Rhode Island and Wisconsin allow X-rays only.
  • A doctorate or extra training in 3: New Mexico, North Dakota and Wisconsin.
  • A duty to pass on the results in 7. Arizona, Iowa, North Dakota and Rhode Island: to the patient's doctor within seven days. New Mexico: to a qualified provider within 30 days. Utah and Wisconsin: coordinate with the patient's physician.
• Yes or not barred, per the board or the rules: 4. Louisiana's and Nevada's boards say PTs may order or refer for imaging. Tennessee's board says no rule or statute prohibits a referral to a radiologist. New Jersey's rules treat ordering a radiological test as part of practice.
• No: 3. North Carolina's rule says a PT shall not order radiological examinations. Georgia's act makes ordering radiology a ground for discipline for a patient who came without a referral. South Carolina's act says nothing in it authorizes a PT to order medical tests.
• Another law decides it: 2. Minnesota's and Hawaii's PT acts are silent, but their X-ray rules say whose order or authorization a technologist may act on, and PTs aren't on either list.
• No specific rule: 33. In 22 of them, the act leaves X-rays, radium or radiology out of physical therapy in some form. That wording bars taking the X-ray, not ordering one, but no board in those states has said so in a document I could find.
• Payment is a separate question. Medicare Part B pays for diagnostic X-rays and other tests ordered by the treating physician or certain nonphysician practitioners. PTs aren't among them.

Every State at a Glance

No specific rule means the PT practice act, the board's rules and the board statements I could find say nothing specific about a PT ordering imaging. The Conditions cell then quotes what the act does say: either a line excluding X-rays from physical therapy, or, if the act is silent, its definition of practice. Each citation links to the official source I read.

Where the Law Says Yes

Any imaging: Arizona, Colorado, DC, North Dakota and Utah

Arizona started with plain films and widened it. A 2025 law struck the limit to "musculoskeletal" imaging "consisting of plain film radiographs." The section now reads: "A physical therapist may order imaging. The imaging shall be performed by a health care practitioner who is authorized pursuant to this title to perform the imaging and shall be interpreted by a physician who is licensed pursuant to chapter 13, 14 or 17 of this title and trained in radiology interpretation." You report the results to the patient's practitioner of record within seven days, and "A physical therapist may order imaging pursuant to this section only for a patient with whom the physical therapist has a physical therapist-patient relationship and for whom there is a clinical need for the order." (A.R.S. § 32-2041.01 (opens in a new tab); Laws 2025, ch. 206 (opens in a new tab)) The definition of practice also says "including ordering imaging" (A.R.S. § 32-2001(13)(a) (opens in a new tab)).

Colorado gets there through its definitions. Physical therapy includes "The administration, evaluation, and interpretation of tests and measurements of bodily functions and structures," and since a 2024 amendment, "'Tests and measurements' means standard methods and techniques used to obtain data about the patient or client, including diagnostic imaging and electrodiagnostic and electrophysiological tests and measures." The discipline section assumes you may order an X-ray: it covers "ordering or performing, without clinical justification, any service, X ray, or treatment that is contrary to recognized standards of the practice of physical therapy as interpreted by the board." (C.R.S. §§ 12-285-104(6), 12-285-120(1)(g) (opens in a new tab))

DC puts it in the definition of practice, with no conditions: the practice of physical therapy includes "the ability to order imaging as part of the evaluation process." (D.C. Code § 3-1201.02(12)(A) (opens in a new tab))

North Dakota adds a qualification and a reporting duty:

1. A physical therapist may order diagnostic imaging if the physical therapist: a. Holds a clinical doctorate degree in physical therapy; or b. Completed a board-approved formal medical imaging training program. 2. A physical therapist ordering diagnostic imaging shall report the results to the patient's designated specialty or primary care provider within seven days of receipt of the image to ensure coordination of care, unless: a. The patient does not have a specialty or primary care provider; or b. The specialty or primary care provider received the images from the health care professional who performed or interpreted the images.

The definition of practice adds that the imaging is "performed by a professional authorized by chapter 43-62 and interpreted by a licensed physician trained in radiology interpretation." (N.D.C.C. §§ 43-26.1-01(14)(a), 43-26.1-11.1 (opens in a new tab))

Utah puts the rule in its radiology technologist act, which normally lets technologists work only on a radiologist's order. Since the 2026 session it reads: "a physical therapist licensed under Chapter 24b, Physical Therapy Practice Act, acting within the scope of the physical therapist's license and experience may order imaging if: (i) the licensed physical therapist designates a physician to receive the results of the imaging; and (ii) the physician designated in Subsection (2)(a)(i) agrees to receive the results of the imaging." You must communicate with the patient's physician unless "a radiologist has read the image and has not identified a significant finding," the patient has no primary care physician, and no provider referred them to you. (Utah Code § 58-54-303 (opens in a new tab)) The PT act lists "ordering imaging in accordance with Section 58-54-303" as part of practice and "taking x-rays" as outside it (Utah Code § 58-24b-102(10) (opens in a new tab)).

Named studies: Iowa and New Mexico

Iowa names two studies: "Physical therapy permits the referral of a patient by a physical therapist for diagnostic imaging, including plain radiographs and magnetic resonance imaging, provided the diagnostic imaging is performed and the results are interpreted by an appropriately licensed and qualified health care professional." The ordering PT reports the results to the patient's primary care provider within seven days, "unless the patient does not have a designated primary care provider or the health care professional who performed and interpreted the diagnostic imaging previously provided the results to the primary care provider." (Iowa Code § 148A.1 (opens in a new tab))

New Mexico is the newest, a board rule in effect since February 24, 2026. It defines imaging and says "Techniques available to Physical Therapists include X-Ray, MRI or CT scan." Only an ordering physical therapist may do it, meaning a "physical therapist holding an entry-level clinical doctorate or transitional clinical doctorate degree in physical therapy" from an accredited program who passed the NPTE and is licensed in New Mexico. Interpretation "Must be completed by a qualified provider, such as a licensed physician, physician assistant, nurse practitioners, dentist, or podiatrist." Then: "The ordering physical therapist will send the results to the qualified provider within 30 days." (16.20.14.7 and .8 NMAC, N.M. Register Vol. XXXVII, Issue 4 (opens in a new tab)) The Register is the official copy I could read; the online code doesn't show this part yet.

X-rays only: Rhode Island and Wisconsin

Rhode Island limits it by definition: "For purposes of this chapter, diagnostic imaging shall include basic radiological imaging, commonly referred to as x-ray imaging, but shall not include other methodologies such as computer topography scan, ultrasound, bone scan, magnetic resonance imaging (MRI), or positron emission tomography scan." (R.I. Gen. Laws § 5-40-1(3) (opens in a new tab)) The ordering section says PTs "may order diagnostic imaging as defined in § 5-40-1 to be performed and interpreted by other licensed healthcare professionals." The section used to end with a sunset: "Unless extended by the general assembly, physical therapists shall not be authorized to order diagnostic imaging as an authorized practice of physical therapy after December 31, 2025." A 2025 law struck that subsection (P.L. 2025, ch. 93 (opens in a new tab)), and the code now shows it as deleted (R.I. Gen. Laws § 5-40-23 (opens in a new tab)). So the authority continues with no end date.

Wisconsin has the most detail. "A physical therapist may order X-rays to be performed by qualified persons only if the physical therapist satisfies one of the following qualifications": a clinical doctorate, a nationally recognized specialty certification, a recognized residency or fellowship, or "a formal X-ray ordering training program with demonstrated physician involvement." Then "When a physical therapist orders an X-ray, the physical therapist shall communicate with the patient's primary care physician or an appropriate health care practitioner to ensure coordination of care, unless all of the following apply": a radiologist read it and found nothing significant, the patient has no primary care physician, and no other practitioner referred the patient. (Wis. Stat. § 448.56(7) (opens in a new tab)) The board's rule says a specialty certification counts only if its clinical hours "include training in the practice of ordering x-rays," and a training program must include "a final examination or other assessment" of competency to order them. (Wis. Admin. Code PT 10.02 (opens in a new tab))

Where the Board Has Answered

Four more states have no law on it, but the board has put an answer in writing, or its rules assume PTs order tests. A board statement is the board's reading of the law, not the law itself, and a later board can change it.

Louisiana. In 2024 the board answered two letters. To an imaging center it said: "Nothing in the Louisiana Physical Therapy Practice Act, La. R.S. 37:2401-2425, nor the Board's Rules, LAC tit. 46: LIV §103 et seq., prohibits a physical therapist from referring or writing a physical order in order to refer to an appropriate healthcare provider or practitioner for medical imaging." It answered yes for imaging that uses radiation, for ultrasound and MRI, and for studies with contrast or isotopes. (Letter to Capitol Imaging Services, Aug. 26, 2024 (opens in a new tab))

To the state PT association it explained the act's X-ray clause: "The Louisiana Physical Therapy Board concludes that the exclusion of 'the use of roentgen rays and radium, isotopes, and ionizing radiation for diagnostic and therapeutic purposes' from the definition of 'physical therapy' in the Practice Act refers to the actual operation of the machine or device that delivers these to the patient and that it in no way limits or restricts the physical therapist's duty to refer." (Letter to APTA Louisiana, Aug. 2, 2024 (opens in a new tab))

Nevada. The board's Advisory Opinion 24-01 found the act silent on referral: "If a physical therapist does a direct referral for diagnostic imaging studies (i.e., x-ray, MRI, CT, Imaging Ultrasound), no NRS or NAC statute has been violated or actionable." It read the act's exclusion the same way Louisiana did: "physical therapists may not diagnose physical disabilities or use (administer) roentenic [sic] rays or radium." Its motion: "Physical Therapists who have training and competencies to order diagnostic imaging including plane [sic] x-rays, MRI, CT scans, and diagnostic ultrasound, are not in violation of the Physical Therapy Practice Act." (Advisory Opinion 24-01, approved July 25, 2024 (opens in a new tab)) Facility rules can still say otherwise. Nevada's rules for ambulatory surgical centers say "Examinations by X-ray must be ordered by the physician or podiatrist responsible for the care of the patient" (NAC 449.993(5) (opens in a new tab)).

Tennessee. At its August 23, 2024 meeting the board answered a question from the state PT association: "Yes, therapist have a duty to refer patients, in the timeliest fashion, to an appropriate healthcare provider/practitioner to assist in managing the case when warranted. No, there isn't a rule/statute that explicitly prohibit physical therapist from referring patients directly to a radiologist for appropriate diagnostics imaging studies." (Board minutes, Aug. 23, 2024 (opens in a new tab)) That says nothing bars it. It isn't a statement that you may.

New Jersey. The rules don't use the word imaging, but they assume a PT may order a test. "'Clinically supported' means that a licensee, prior to selecting, performing or ordering the administration of a diagnostic test," has examined the patient, considered earlier tests and documented the reasons. "'Diagnostic testing' means a medical service utilizing biomechanical, neurological, neurodiagnostic, radiological, vascular or any means, other than bioanalysis, intended to assist in establishing a physical therapy diagnosis." What a PT may not do is "The taking of radiological studies." (N.J.A.C. 13:39A-2.1, 2.2(e) (opens in a new tab)) The board's own link to this PDF no longer works, and the official code is only in LexisNexis, so this archived copy of the board's file is the version I could read.

Boards in other states may have answered this question, either way, in letters or opinions that aren't posted. I found none on the Maryland, Mississippi or West Virginia board sites, and Alaska's board site blocked my access. If you practice in one of those states, ask the board whether it has issued one.

Where the Rules Say No

North Carolina says it outright in a board rule: "Physical therapy does not include the application of roentgen rays or radioactive materials, but consistent with the requirements of G.S. 90-270.102(4) a physical therapist may review x-rays and may also request radiologic consultations; however, a physical therapist shall not order radiological examinations." (21 NCAC 48C .0103(c) (opens in a new tab))

Georgia puts it in the discipline section. The board may discipline a PT who gave care without a proper examination and evaluation, and for "patients who have self-referred," that includes having "Ordered radiology, performed surgery, ordered laboratory or body fluid testing." The same list requires a written disclosure to each self-referred patient that a PT diagnosis isn't based on radiological imaging. (O.C.G.A. § 43-33-18(a)(2), HB 505 (2015) (opens in a new tab)) Read as written, the ground applies to patients who came without a referral. For a referred patient the act doesn't say.

South Carolina doesn't name imaging, but its definition of practice ends: "nothing in this chapter shall be construed to authorize a physical therapist to prescribe medications or order laboratory or other medical tests." (S.C. Code § 40-45-20(9) (opens in a new tab)) An imaging study is a medical test, so I've counted it as a no.

When Another Law Decides It

The PT act isn't the only law that matters. Radiation-control rules often say whose order a technologist may act on, and some states' PT boards point to that law.

Minnesota is the clearest case I found. Its PT act says nothing about imaging, but the Department of Health's X-ray rule does: "The order for a radiographic examination can be made only by a licensed practitioner of the healing arts, a certified clinical nurse specialist, certified nurse midwife, certified nurse practitioner, or physician assistant," and "The operator must not carry out a radiographic procedure unless ordered by individuals listed in this subpart." (Minn. R. 4732.0560 (opens in a new tab)) A licensed practitioner of the healing arts means those licensed "for the lawful practice of medicine, dentistry, veterinary medicine, osteopathic medicine, chiropractic, and podiatry." (Minn. R. 4732.0110, subp. 101 (opens in a new tab)) So in Minnesota an X-ray order from a PT can't be carried out. The rule covers radiation, so it doesn't reach MRI.

Hawaii's radiation rule works the same way, through the person who authorizes the exposure: "Individuals shall not be exposed to the useful beam except for healing arts purposes and unless such exposure has been authorized by a licensed practitioner of the healing arts." The rule defines the healing arts: "'Healing arts' means the medical, dental, chiropractic, podiatric, and veterinary professions." (HAR §§ 11-45-2, 11-45-116 (opens in a new tab)) The copy the Department of Health posts is the 1999 adoption, and I couldn't confirm later amendments, so check the current rule.

Louisiana's board flagged the same issue, telling an imaging center to look at the radiologic technologist law on who may have radiation applied to a patient. I didn't check every state's radiation-control rules, so a state marked No specific rule above can still have one of these.

The Roentgen Rays Clause

Twenty-two of the states with no specific rule, and several others, have a line like Connecticut's: physical therapy does not include "the use of Roentgen rays or radium for diagnostic or therapeutic purposes" (Conn. Gen. Stat. § 20-66(2) (opens in a new tab)). Roentgen rays are X-rays. Others say radiology (Alabama, Arkansas, Idaho, Illinois), taking X-rays (Maryland (opens in a new tab)), or "the administration of x-radiation, radioactive substance, diagnostic x-ray" (Missouri (opens in a new tab)).

These clauses bar you from taking the X-ray. None of them mentions ordering one. The two boards that have read their clause, Louisiana and Nevada, said it covers using the machine and doesn't stop a referral. Utah's act shows the two are separate: it lists "taking x-rays" as outside physical therapy and ordering imaging as inside it. Still, a clause like this is not permission. Until your board says otherwise, treat the question as open.

Medicare, Payers and Facilities

What a state allows and what a payer covers are separate.

Medicare Part B. The rule for diagnostic tests reads: "Except as otherwise provided in this section, all diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary." It treats certain other practitioners the same as physicians: "Nonphysician practitioners (that is, clinical nurse specialists, clinical psychologists, clinical social workers, marriage and family therapists, mental health counselors, nurse-midwives, nurse practitioners, and physician assistants)." Physical therapists aren't on that list, and "Tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary." (42 CFR 410.32(a) (opens in a new tab))

In the home. Medicare's conditions for portable X-ray suppliers say "Portable X-ray examinations are performed only on the order of a physician licensed to practice in the State or by a nonphysician practitioner acting within the scope of State law," with nonphysician practitioners defined by the same Part B rule. (42 CFR 486.106(a) (opens in a new tab)) In home health, then, the practical step is to tell the certifying physician or allowed practitioner what you found and ask them to order the study.

Private plans and facilities. Commercial insurers, Medicaid plans, hospitals and imaging centers each decide whose orders they accept and pay on. A state law that lets you order imaging doesn't make any of them take your order. Check with the payer and the imaging site before the patient goes.

If you work across state lines or on a compact privilege, the rule of the state where the patient is located applies. Our PT compact page lists the member states, and the licensure compact tool links each state's PT board.

Key Takeaways

• Nine jurisdictions allow PT imaging orders in a statute or rule: Arizona, Colorado, DC, Iowa, New Mexico, North Dakota, Rhode Island, Utah and Wisconsin.
• Rhode Island and Wisconsin allow X-rays only. Iowa names X-rays and MRI, New Mexico X-ray, MRI and CT.
• New Mexico, North Dakota and Wisconsin require a doctorate or specific training, and seven of the nine make you pass on the results or coordinate with the patient's doctor.
• Louisiana and Nevada boards say PTs may order or refer for imaging. Tennessee's board says nothing bars it, and New Jersey's rules assume PTs order tests.
• North Carolina, Georgia (self-referred patients) and South Carolina say no. Minnesota's and Hawaii's X-ray rules leave PTs off the list of who may order or authorize an X-ray.
• In 33 states the PT rules don't address it. A clause excluding the use of X-rays bars taking them, not ordering them, but silence is not permission.
• Medicare Part B pays for diagnostic tests ordered by the treating physician or listed practitioners, and PTs aren't listed.
• This isn't legal advice. I checked these rules on November 9, 2026, and your board's current rule is the one that counts.

Frequently asked questions

Can a physical therapist order an X-ray?

In some states, yes. Nine jurisdictions allow it in a statute or rule: Arizona, Colorado, DC, Iowa, New Mexico, North Dakota, Rhode Island, Utah and Wisconsin. Rhode Island and Wisconsin allow X-rays only. Boards in Louisiana and Nevada have said PTs may, Tennessee's board has said nothing bars it, and New Jersey's rules treat ordering a radiological test as part of practice. North Carolina's rule says a PT shall not order radiological exams. In the other states the rules don't say.

Can a physical therapist order an MRI?

In fewer places than an X-ray. Arizona, Colorado, DC, North Dakota and Utah allow imaging without naming a type, Iowa names plain radiographs and MRI, and New Mexico names X-ray, MRI and CT. Rhode Island's law covers X-rays only and lists MRI as excluded, and Wisconsin's covers only X-rays. Louisiana's and Nevada's boards have said MRI referrals don't violate their acts. Everywhere else the rules are silent or say no.

Will Medicare pay for imaging a physical therapist orders?

Under Part B, generally not. Medicare's rule says diagnostic X-rays and other diagnostic tests must be ordered by the physician treating the patient, and it extends that to nurse practitioners, clinical nurse specialists, physician assistants and a few others. Physical therapists aren't on the list. A state law that lets you order imaging doesn't change who Medicare or a private plan will pay on, so check the payer before you send the order.

Can a physical therapist assistant order imaging?

No state's rules give that to a PTA. Where a law spells out who may order imaging, it names the physical therapist, and New Mexico, North Dakota and Wisconsin also require a doctorate or specific training. In the rules I read, deciding a patient needs imaging is part of the evaluation, and the evaluation stays with the PT.

What does it mean that physical therapy doesn't include the use of roentgen rays?

Roentgen rays are X-rays. Twenty-two of the states with no specific rule on ordering leave X-rays, radium or radiology out of physical therapy in some form. That wording bars a PT from taking the X-ray. It doesn't say anything about ordering one. Louisiana's board has said its clause refers to operating the machine and doesn't limit a referral for imaging. Other boards haven't said either way.

Sources

Every state's rule is linked in the table, to the state's legislature, its official code publisher or its PT board. All were read on November 9, 2026.

• Arizona Laws 2025, chapter 206 (opens in a new tab) (HB 2583), amending A.R.S. § 32-2041.01.
• New Mexico Register, Volume XXXVII, Issue 4 (opens in a new tab), February 24, 2026: 16.20.14 NMAC (Imaging). The State Records Center's issue page (opens in a new tab) links this PDF.
• Louisiana Physical Therapy Board, letters of August 2, 2024 (opens in a new tab) and August 26, 2024 (opens in a new tab) on imaging referral.
• Nevada State Board of Physical Therapy, Advisory Opinion 24-01 (opens in a new tab).
• Tennessee Board of Physical Therapy, minutes of August 23, 2024 (opens in a new tab).
• Minnesota Rules 4732.0560 (opens in a new tab) and 4732.0110 (opens in a new tab) (X-ray orders), and Hawaii Administrative Rules chapter 11-45 (opens in a new tab) (radiation control).
• 42 CFR 410.32 (opens in a new tab) (Medicare diagnostic tests) and 486.106 (opens in a new tab) (portable X-ray services).