Can Occupational Therapists Treat Dysphagia? The Rules in Every State

In most states, yes. Twenty-four states and DC name swallowing in the occupational therapy practice act or the board's rules, most of them in the same model wording about managing feeding, eating and swallowing. Two states add a requirement on top: California makes swallowing an advanced practice that needs board approval, and Indiana requires shown competency before an OT works on the pharyngeal phase or does instrumental studies. Seventeen states don't mention swallowing, feeding or eating at all, which means the act is silent, not that the answer is no.

This article goes through every state for OTs and OTAs: what the act or rules say in their own words, any extra requirement, what they say about assistants, and a link to the source. I'm an OT, and I've stuck to what the rules say rather than what I've seen done in practice.

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

• Swallowing named in the act: 16 states. Alabama, California, Colorado, Florida, Hawaii, Idaho, Illinois, Indiana, Maine, Michigan, Minnesota, Montana, Nebraska, New Mexico, Ohio and West Virginia. Florida's is inside its definition of activities of daily living.
• Named in the board's rules only: 9. DC, Iowa, Kentucky, Mississippi, North Carolina, North Dakota, Oregon, Texas and Wisconsin. Kentucky's is an activities-of-daily-living list too.
• A board statement, not the law: 2. Maryland's board says feeding and swallowing therapy is within OT scope. Massachusetts's board said the same in its June 2020 minutes.
• Feeding, eating or oral-motor words, but not swallowing: 6. Delaware, Missouri and Rhode Island name oral-motor functioning. Louisiana, South Dakota and Utah name eating or feeding.
• Not named at all: 17. Alaska, Arizona, Arkansas, Connecticut, Georgia, Kansas, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Pennsylvania, South Carolina, Vermont, Virginia, Washington and Wyoming.
• Couldn't verify: Tennessee. Its board rules don't name swallowing, and its statute is published only through LexisNexis, which I couldn't open.
• Extra requirements in law: 2. California (board approval after 45 contact hours and 240 hours of supervised training) and Indiana (competency for the pharyngoesophageal phase and instrumental evaluations). The Massachusetts and Oregon boards call parts of it advanced.
• OTAs: only a few sources speak to assistants and swallowing directly: California's board FAQ, Maryland's and Ohio's board statements, Oregon's board page, and Indiana's statute, which names only the OT. Everywhere else the general OTA supervision rules apply.

Every State at a Glance

How to read the second column. Named means the act or rules use the word swallowing. Named in rules means the board's rules do and the act doesn't. Feeding or eating only and Oral-motor only mean the act uses those words but not swallowing. Not named means the act, the rules and the board's published statements say none of these things. Each citation links to the official source I read.

The Two States With Extra Requirements

California: an advanced practice that needs board approval

California's OT act lists swallowing with hand therapy and physical agent modalities as an advanced practice. "An occupational therapist may provide advanced practices if the occupational therapist has the knowledge, skill, and ability to do so and has demonstrated to the satisfaction of the board that the occupational therapist has met educational training and competency requirements." (B&P Code § 2570.3(d) (opens in a new tab))

The board's rules say what that means. Swallowing, for this purpose, starts at the pharynx (16 CCR § 4150(h) (opens in a new tab)):

"Swallowing" as used in Code section 2570.3 is the passage of food, liquid, or medication through the pharyngeal and esophageal phases of the swallowing process.

And the requirement itself, from 16 CCR § 4153 (opens in a new tab):

(a) The role of an occupational therapist in instrumental evaluations is to observe structure and function of the swallowing mechanism in order to assess swallowing capability and determine swallowing interventions. The occupational therapist may not perform the physically invasive components of the instrumental evaluation. (b) Swallowing assessment, evaluation or intervention may be performed only when an occupational therapist has demonstrated to the Board that they have met the post professional education and training requirements established by this section as follows: (1) Education: Completion of 45 contact hours in the following subjects: ...

The training is "Completion of 240 hours of supervised on-the-job training, clinical internship or affiliation, which may be paid or voluntary, pertaining to swallowing assessment, evaluation or intervention." While you're completing it, you may practice "under the supervision of an occupational therapist who has been approved under this article, a speech language pathologist with expertise in this area, or a physician and surgeon." (16 CCR § 4153(b)(2) (opens in a new tab))

What stays entry level? The board's advanced practice FAQ (opens in a new tab) answers it: "It is appropriate for the entry-level therapist to make oral intake texture/consistency recommendations, position changes, and oral motor interventions." But "Further evaluation of aspiration risk and development of an intervention plan is considered advanced practice, requiring advanced practice approval." The same FAQ says that using electrical stimulation such as VitalStim to improve swallowing needs "advanced practice approval in physical agent modalities in addition to dysphagia." I cover that second approval in physical agent modalities by state.

For assistants, the board's supervision FAQ (opens in a new tab) says an OTA can't get advanced practice approval: "Advanced Practice certification is only available to licensed occupational therapists who have demonstrated to the Board that he/she has met the Board's post professional education and training requirements." But an OTA can provide the treatment: "Yes, however, the OTA must be supervised by an OT who has been approved by the Board in the appropriate advanced practice area."

California's is also the one act I read that ties swallowing to the line with speech-language pathology: "This chapter does not authorize an occupational therapist to practice ... speech-language pathology or audiology, as defined in Section 2530.2 ... except as authorized by this section." (B&P Code § 2570.3(c) (opens in a new tab)) Swallowing is authorized by that same section, through the advanced practice approval.

Indiana: competency for the pharyngeal phase

Indiana's act names feeding, eating and swallowing in the general scope, then adds a section of its own, from IC 25-23.5-4-2 (opens in a new tab):

(a) An occupational therapist may assess and manage the pharyngoesophageal phase of swallowing, including instrumental evaluations, only if the occupational therapist has done the following: (1) Obtained continuing competency specific to the assessment and management of swallowing disorders. (2) Demonstrated competencies specific to the evaluation and management of pharyngoesophageal swallowing disorders within the practitioner's service delivery setting and with the specific populations through, at a minimum: (A) professional development or similar advanced training; (B) successful passage of a written test; and (C) demonstrated clinical skills and knowledge. (b) The competencies required under subsection (a)(2) must be annually reviewed and updated.

The statute sets no board approval step like California's. It sets the competencies and says they must be reviewed every year. It speaks of the occupational therapist only and says nothing about assistants.

Boards That Have Spoken

Four boards have put a position in writing. None of these is a statute or rule, but each tells you how the board reads its own act.

• Maryland. The act doesn't name swallowing, but the board's 2007 position statement says: "It is the position of the Board of Occupational Therapy Practice that feeding and swallowing therapy is within the scope of practice of occupational therapy. Licensed occupational therapists and occupational therapy assistants are authorized to carry out a treatment program to remediate or restore performance abilities in the functional areas of swallowing, feeding, and eating that are limited due to impairment in biological, physiological, psychological or neurological processes." It adds that "Swallowing therapy must be provided consistent with the Code of Ethics." (Maryland Board of Occupational Therapy Practice (opens in a new tab))
• Massachusetts. Answering an email in June 2020, the Board of Allied Health recorded: "Generally, dysphagia evaluation and treatment is within the scope of practice of occupational therapy within the Commonwealth of Massachusetts, although performing a modified barium swallow study is an advanced modality for which specialized training and supervised practice may be required." (Board minutes, June 25, 2020 (opens in a new tab))
• Ohio. The act names it, and the board's 2005 position statement ends: "Since swallowing/eating is clearly an activity of daily living, individuals having difficulty in eating/swallowing may be legally treated by a licensed occupational therapist and licensed occupational therapy assistant. Therefore, based on the education, certification and licensure process, and Ohio law, the assessment and treatment of dysphagia are within the scope of occupational therapy practice." (Ohio OT, PT and AT Board (opens in a new tab)) It is dated 2005, and the board still lists it on its scope of practice page.
• Oregon. The rule names it, and the board's practice topics page (opens in a new tab) quotes its August 2023 minutes: "Dysphagia management is an advanced practice and like all OT practice, the therapist must be competent and comfortable with what they are being asked to do. Therapists must self-assess whether they have the training, skill set and comfort level to do the intervention. If not, they should not be doing it." The same page quotes the education standards: OTs are trained to "Evaluate and provide interventions for dysphagia and disorders of feeding and eating to enable performance," and OTAs to "Demonstrate interventions that address dysphagia and disorders of feeding and eating."

The Common Wording, and What Varies

Twenty of the 25 jurisdictions that name swallowing use some version of one phrase, "Management of feeding, eating, and swallowing to enable eating and feeding performance." Oregon's board says where it comes from. When it amended its rule in 2024, it replaced "Management of feeding and eating to enable swallowing performance" with the current wording, "(Per the 2022 AOTA Practice Act)." (Oregon OT Licensing Board, laws and rulemaking (opens in a new tab))

The variations:

• Longer: Colorado says "to support eating and feeding performance necessary for nutrition, social participation, or other health or wellness considerations" (C.R.S. § 12-270-104 (opens in a new tab)). Illinois says "to enable or enhance performance of these tasks" (225 ILCS 75/2 (opens in a new tab)).
• Shorter: Michigan and New Mexico stop at management of feeding, eating and swallowing. The compiler's note to New Mexico's section says a later amendment took out the rest of the phrase (NMSA 1978, § 61-12A-3 (opens in a new tab)).
• Skills, not management: Minnesota lists "feeding and swallowing skills" (Minn. Stat. § 148.6404 (opens in a new tab)), and Montana "developing feeding and swallowing skills" (MCA 37-24-103 (opens in a new tab)).
• In a list of activities of daily living: Florida's definition of activities of daily living includes "functional mobility, bathing, dressing, eating and swallowing, personal hygiene and grooming, toileting, and other similar tasks" (Fla. Stat. § 468.203(4)(a) (opens in a new tab)). Kentucky's basic activities of daily living include "Swallowing, eating, and feeding" (201 KAR 28:010 (opens in a new tab)).

In 16 states the words are in the act. In DC, Iowa, Kentucky, Mississippi, North Carolina, North Dakota, Oregon, Texas and Wisconsin they're in the board's rules, which the board adopts under its act and which carry the force of law.

Feeding, Eating or Oral-Motor, but Not Swallowing

Six states name part of it. Delaware, Missouri and Rhode Island include oral-motor functioning in the list of what OT develops or restores. Louisiana's rules count eating and feeding as self-care skills, South Dakota's act names "assessment of development of self-care and feeding" (SDCL 36-31-1 (opens in a new tab)), and Utah's names "enhancing eating and feeding performance" (Utah Code § 58-42a-102 (opens in a new tab)).

These words name the activity of eating or the muscles of the mouth. They don't say swallowing, and none of these six boards has published anything I could find on whether its act reaches dysphagia treatment. I haven't read more into them than they say.

What Medicare Says

Medicare is a payer, not a licensing board. Its rules decide what it pays for, not what your license allows, so I've kept them separate.

• The national policy is written for speech-language pathology. The national coverage determination is titled "Speech-Language Pathology Services for the Treatment of Dysphagia" and says "Speech-language pathology services are covered under Medicare for the treatment of dysphagia, regardless of the presence of a communication disability." (NCD Manual, ch. 1, part 3, § 170.3 (opens in a new tab))
• So is the Benefit Policy Manual's dysphagia text. It sits in the speech-language pathology section, § 230.3: "For these reasons, it is important that only qualified professionals with specific training and experience in this disorder provide evaluation and treatment. The speech-language pathologist performs clinical and instrumental assessments and analyzes and integrates the diagnostic information to determine candidacy for intervention as well as appropriate compensations and rehabilitative therapy techniques." The occupational therapy section, § 230.2, gives "Teaching a stroke patient new techniques to enable the patient to perform feeding, dressing, and other activities as independently as possible" as an example, and doesn't mention dysphagia. (Medicare Benefit Policy Manual, ch. 15 (opens in a new tab)) Neither national document names OTs for dysphagia, for or against.
• Home health counts swallowing as a function every therapist measures. For PT, OT and speech-language pathology alike, the objective measurements "would be made by the qualified therapist using measurements which assess activities of daily living that may include but are not limited to eating, swallowing, bathing, dressing, toileting, walking, climbing stairs, or using assistive devices, and mental and cognitive factors." (42 CFR 409.44(c)(1)(iv) (opens in a new tab))
• One contractor names it in its OT policy. Palmetto GBA's Home Health Occupational Therapy LCD says "this policy only addresses OT," and among its procedure guidelines lists "Evaluation of oral and pharyngeal swallowing function" and "Treatment of swallowing dysfunction and/or oral function for feeding," which "involves the treatment for impairments/functional limitations of mastication, the preparatory phase, oral phase, pharyngeal stage and esophageal phase of swallowing." The LCD lists its home health jurisdiction as Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Texas. (L34560 (opens in a new tab)) Palmetto's outpatient OT LCD has the same two entries (L34427 (opens in a new tab)).
• Instrumental studies, by the same contractor: "The videofluoroscopic swallowing study is a collaborative study that can be performed by a speech-language pathologist and a radiologist." (L33449, Swallowing Studies for Dysphagia (opens in a new tab))
• Surface electrical stimulation: Palmetto doesn't cover it in home health. "There is insufficient scientific or clinical evidence to consider this device as reasonable and necessary for the treatment of dysphagia." (L34565 (opens in a new tab))

The outpatient PT and OT LCDs from CGS (L34049) (opens in a new tab) and Wellpoint Federal (L33631) (opens in a new tab) don't mention swallowing or dysphagia. If your agency bills another contractor, read that contractor's policy before you assume either way.

If You're Asked to Treat Dysphagia in Home Health

None of this is legal advice. It's what the rules above have in common, put as steps.

1. Find your state's row. If swallowing is named, that's your authority. If it isn't, ask the board before you start, not after a denial or a complaint.
2. In California, get approved first. Without advanced practice approval, stay with the entry-level work the board's FAQ describes and refer when you suspect aspiration.
3. In Indiana, keep your competency file. Training, the written test, shown skills, reviewed every year, before you work on the pharyngeal phase.
4. Work inside your competence. California's rule says it outright, and the Maryland and Oregon boards point to their competence rules on this exact topic.
5. Be careful with instrumental studies. California bars an OT from the physically invasive parts, Indiana requires its competency steps first, and no other state's OT act or rules address them. Ask your board before you take part in one.
6. Assistants follow the OT. The OT evaluates and writes the plan; the OTA carries it out under the state's supervision rules. See assistant visits and which visit comes first.
7. Treating across state lines? The rules of the state where the patient is are the ones that apply, including on a compact privilege. Our OT compact page covers which states are in.

Key Takeaways

• 24 states and DC name swallowing in the OT act or rules, most in the words management of feeding, eating and swallowing.
• California requires advanced practice approval, and Indiana requires yearly competency for the pharyngeal phase and instrumental studies.
• Boards in Maryland, Massachusetts, Ohio and Oregon have said in writing that dysphagia is within OT practice.
• 17 states don't mention swallowing, feeding or eating. That's silence, not permission, so ask your board.
• Medicare's national dysphagia policy is written for speech-language pathology, but Palmetto GBA's home health OT policy names swallowing evaluation and treatment.
• 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 occupational therapists treat dysphagia?

In most states the OT practice act or the board's rules say so in plain words. Sixteen states name swallowing in the act itself and nine more, including DC, name it in the board's rules. Boards in Maryland and Massachusetts have said it is within OT scope even though their acts don't name it. Seventeen states don't mention swallowing, feeding or eating at all, which leaves the question to the board. Tennessee I couldn't verify.

Do OTs need special training or certification to treat swallowing?

Only two states put it in law. California makes swallowing assessment, evaluation and intervention an advanced practice: you need board approval after 45 contact hours of education and 240 hours of supervised training. Indiana requires continuing competency, a written test and shown clinical skills before an OT works on the pharyngoesophageal phase or does instrumental evaluations, reviewed every year. The Massachusetts and Oregon boards call parts of it advanced, and no other state's act or rules set a training requirement for it.

Can a COTA or OTA treat dysphagia?

Few states say. Ohio's and Maryland's boards name occupational therapy assistants as able to carry out swallowing treatment. California doesn't let an OTA get advanced practice approval, but an OTA may treat under an OT who has it. Indiana's statute on the pharyngeal phase names only the occupational therapist. Everywhere else the state's general OTA supervision rules apply.

Does Medicare pay for occupational therapy for dysphagia?

Medicare's national dysphagia policy is written for speech-language pathology and doesn't name OTs either way. In home health, the federal rule lists eating and swallowing among the functions a qualified therapist measures. Palmetto GBA, whose home health jurisdiction covers 16 states, lists evaluation of oral and pharyngeal swallowing function and treatment of swallowing dysfunction in its occupational therapy policy. Check your own contractor's policy.

Can an OT do a modified barium swallow study or FEES?

California lets an approved OT take part in instrumental evaluations, to observe the swallow, but not perform the physically invasive parts. Indiana allows instrumental evaluations only after the competency steps in its statute. Massachusetts's board called the modified barium swallow study an advanced modality that may need specialized training and supervised practice. No other state's OT act or rules address instrumental studies.

Sources

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

• California Board of Occupational Therapy, advanced practice FAQ (opens in a new tab) and supervision FAQ (opens in a new tab).
• Maryland Board of Occupational Therapy Practice, Feeding and Swallowing Therapy: OT and OTA Authority to Perform (opens in a new tab), approved May 18, 2007.
• Massachusetts Board of Registration in Allied Health Professionals, public meeting minutes, June 25, 2020 (opens in a new tab).
• Ohio OT, PT and AT Board, Occupational Therapy Section, The Role of the Occupational Therapy Practitioner in the Evaluation and Treatment of Dysphagia (opens in a new tab), September 6, 2005.
• Oregon Occupational Therapy Licensing Board, practice topics (opens in a new tab) and laws and rulemaking (opens in a new tab).
• CMS, Medicare Benefit Policy Manual, chapter 15 (opens in a new tab), §§ 230.2 and 230.3, and National Coverage Determinations Manual, chapter 1, part 3 (opens in a new tab), § 170.3.
• 42 CFR 409.44 (opens in a new tab), skilled services requirements for home health.
• Palmetto GBA local coverage determinations: L34560 Home Health Occupational Therapy (opens in a new tab), L34427 Outpatient Occupational Therapy (opens in a new tab), L33449 Swallowing Studies for Dysphagia (opens in a new tab) and L34565 Home Health Surface Electrical Stimulation in the Treatment of Dysphagia (opens in a new tab).