Can a Physical Therapist Do Sharp Wound Debridement? The Rules in Every State

In 25 of the 50 states and DC, the law or the board says a physical therapist may debride wounds. Twenty-one name debridement in the PT practice act or rules, 7 of them name sharp debridement outright, and 4 more boards have said so in writing. In the other 26 the rules don't name debridement at all. Seven states attach a condition, usually a physician's order, referral or authorization. For PTAs the answer is more often no or unclear: 4 states bar PTAs from sharp debridement, 2 boards allow it in limited cases, and most say nothing.

This matters in home health, where the PT is often the one at the bedside with a wound that needs work. This article goes through every state for PTs and PTAs: whether debridement is in scope, the conditions, the PTA rule and a link to the source. 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

• Debridement named in the law or rules: 21 states. Arizona, Arkansas, Colorado, Delaware, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, South Dakota, Tennessee, Texas, Utah and Washington.
• Sharp debridement named outright: 7. Colorado, Indiana, Louisiana, Nebraska, Texas, Utah and Washington. Delaware and Nebraska's acts say "nonsurgical debridement."
• Board statement only: 4. In Kentucky, New York, South Carolina and Virginia the law is general, but the board has said sharp debridement is within PT scope. Nebraska's board has said so too.
• Wound care or skin named, debridement not: 4. Florida, Hawaii, West Virginia and Wyoming. Kentucky's act also names only the integumentary system, and its board fills the gap.
• Nothing on wound care or debridement, and no board statement: 22. Alabama, Alaska, California, Connecticut, DC, Georgia, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Vermont and Wisconsin.
• Conditions in the law: 7. Arkansas, Colorado, Illinois, Indiana, Kansas, New Jersey and Washington require a referral, order, authorization, approval or contact with the physician. Washington also requires proof of training. Virginia's board adds referral and direction.
• PTAs: 4 states bar sharp debridement (Colorado, Nebraska, Utah, Washington). 3 name only PTs in their debridement rule (Illinois, Louisiana, New Jersey). 2 boards allow it in limited cases (North Carolina, Virginia). The other 42 don't address it.
• Medicare pays for selective debridement by a PT (CPT 97597 and 97598) as therapy under a plan of care, and leaves who may do it to state law.

Every State at a Glance

No specific rule means the act, the rules and the board's published statements don't name debridement or wound care; the cell quotes the scope definition that governs. Not addressed means nothing on PTAs and debridement. Only PTs named means the debridement rule speaks of physical therapists and says nothing either way about assistants. Each citation links to the official source I read.

The States That Spell It Out

Sharp debridement named in the law

• Colorado has the most complete rule. The act lists "General wound care and wound debridement, including the assessment and management of skin lesions, surgical incisions, open wounds, and areas of potential skin breakdown in order to maintain or restore the integumentary system. Wound debridement includes sharp debridement and nonsharp debridement, such as mechanical, autolytic, enzymatic, and maggot." A PT may debride "under a physician's order, the order of a physician assistant authorized under section 12-240-107 (6), or the order of an advanced practice registered nurse authorized under section 12-255-111 when debridement is consistent with the scope of physical therapy practice," and "The performance of wound debridement does not violate the prohibition against performing surgery." (C.R.S. §§ 12-285-104(6)(a)(II)(F) and 12-285-116(3), 2024 edition (opens in a new tab))
• Washington defines it: "'Sharp debridement' means the removal of devitalized tissue from a wound with scissors, scalpel, and tweezers without anesthesia. 'Sharp debridement' does not mean surgical debridement. A physical therapist may perform sharp debridement, to include the use of a scalpel, only upon showing evidence of adequate education and training as established by rule." Wound care is allowed "only by referral from or after consultation with an authorized health care practitioner." (RCW 18.74.010(11)(d), (13) (opens in a new tab)) The rule sets the training: "Twenty hours of mentored sharp debridement training in a clinical setting that includes observation, cotreatment, supervised treatment, and a case mix similar to the physical therapists' expected practice," or certification as a wound care specialist by a listed organization. (WAC 246-915-360 (opens in a new tab))
• Indiana defines "Sharp debridement" as "the removal of foreign material or dead tissue from or around a wound, without anesthesia and with generally no bleeding," with a scalpel, scissors, forceps, tweezers or other sharp instruments. Then: "A physical therapist may not perform sharp debridement unless the physical therapist is acting on the order or referral of a" physician, osteopath or podiatrist. (IC 25-27-1-1(7) and 25-27-1-3.5 (opens in a new tab))
• Louisiana defines wound debridement as "patient care provided by a PT, provisionally licensed PT, or student PT, which removes non–living tissue from pressure ulcers, burns and other wounds as part of wound management, including but not limited to, sharps debridement, debridement with other implements or agents and application of topical agents including enzymes." (La. Admin. Code tit. 46, pt. LIV, § 123 (opens in a new tab))
• Texas puts it in the board's definition of physical therapy: practice includes "application of topical medication to open wounds, sharp debridement, provision of soft goods, inhibitive casting and splinting." (22 TAC § 321.1(15) (opens in a new tab))
• Utah lists "wound debridement, cleansing, and dressing" among the therapeutic interventions (Utah Code § 58-24b-102(14)(i) (opens in a new tab)) and bars assistants from the sharp part (below).
• Nebraska's act says "nonsurgical debridement and wound care" (Neb. Rev. Stat. § 38-2914 (opens in a new tab)), and its rule names sharp debridement as a PT's job: on each date of service a PT must "Provide all therapeutic interventions that require the expertise of a physical therapist for example, sharp wound debridement and high velocity low amplitude manual therapy techniques." (172 NAC 137-008.03(F)(i) (opens in a new tab))

Conditions in the other states

• Arkansas: "The therapeutic intervention of bronchopulmonary hygiene and debridement of wounds require a physician referral before initiation of treatment." It is one of the few procedures Arkansas carves out of direct access. (Ark. Code § 17-93-102(7)(B)(ii) (opens in a new tab), board's copy)
• Illinois: "Wound debridement services may only be provided by a physical therapist with written authorization from a health care professional." (225 ILCS 90/1.2(d) (opens in a new tab))
• Kansas: "Physical therapists shall perform wound debridement services only after approval by a person licensed to practice medicine and surgery or other licensed health care practitioner in appropriately related cases." (K.S.A. 65-2921(f) (opens in a new tab))
• New Jersey: the 2017 law defines "Wound debridement and care" as "the removal of loosely adhered necrotic and nonviable tissue, by a physical therapist, to promote healing, done in conjunction with a physician or podiatric physician" (P.L.2017, c.121 (opens in a new tab)). The board's rule: "A licensed physical therapist shall perform wound debridement only after communicating with the patient's licensed physician or licensed podiatric physician," and you must keep documentation of that communication. In adopting it, the board said the statute "does not authorize a physical therapist to perform wound debridement in conjunction with an advanced practice nurse." (N.J.A.C. 13:39A-2.2A, 51 N.J.R. 894(a) (opens in a new tab)) The consolidated code is online only through LexisNexis, so these are the official texts I could read.
• Delaware and Nebraska say "nonsurgical debridement." Neither act defines the word. Washington and Colorado both say sharp debridement isn't surgery.

Where the board, not the law, answers it

These five boards answered the question in writing. A board statement tells you how the board reads the act; it isn't the act.

• Kentucky. The board's FAQ asks whether sharp wound debridement is within the scope of physical therapy under KRS 327.010(1), and answers yes. It points to the act's "invasive or noninvasive procedures" wording and says: "There is nothing in KRS Chapter 327 to prohibit a credential holder from performing sharp wound debridement so long as he or she has the requisite training, expertise, and experience to perform this function." (Board FAQ (opens in a new tab); KRS 327.010(1) (opens in a new tab))
• Nebraska. "It is the opinion of the Board of Physical Therapy that a Nebraska licensed physical therapist may perform sharp wound debridement as long as he/she can competently perform such procedure. This does not include physical therapist assistants." The opinion was adopted in January 1986 and updated in August 1996. (Board opinion (opens in a new tab))
• New York. "Section 6731 of the Education Law does not provide specific language regarding debridement or wound care. Debridement of a wound using a scalpel was determined from a review of physical therapy education programs to be within the physical therapy scope when done in conjunction with the provision of physical therapy treatment." The alert also says "Wound care must be provided in conjunction with the provision of physical therapy treatment," and that not following a guideline "may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations." (Practice Alert 13 (opens in a new tab))
• South Carolina. The board's FAQ says PT wound care "has included, but has not been limited to, whirlpool or other forms of hydration, debridement of a sharp or blunt nature or by use of other mechanical or chemical agents (specifically prescribed by a physician when appropriate), and dressing changes," and "The Board has taken no steps to limit the practice of physical therapy in this area." (Board FAQ (opens in a new tab))
• Virginia. "Sharp debridement is an invasive procedure and requires referral and direction from a licensed practitioner, in accordance with Virginia Code § 54.1-3482. Sharp debridement requires specific skills and training in wound care and on-going evaluation by the physical therapist." (Guidance Document 112-14 (opens in a new tab)) The statute it relies on says "Invasive procedures within the scope of practice of physical therapy, except for the practice of dry needling, shall at all times be performed only under the referral and direction of" a doctor of medicine, osteopathy, chiropractic, podiatry or dental surgery, or the other practitioners it lists. (Va. Code § 54.1-3482(D) (opens in a new tab))

States that say nothing

In 22 jurisdictions the act and rules don't mention wound care or debridement, and I found no board statement. Most define physical therapy by its agents: heat, cold, water, electricity, sound, exercise and massage. A few draw an outer line. Connecticut's definition "does not include surgery" (Conn. Gen. Stat. § 20-66(2) (opens in a new tab)), and Missouri's "does not include the use of surgery or obstetrics" (RSMo § 334.500 (opens in a new tab)). Neither says whether sharp debridement counts as surgery. California and Montana let PTs apply topical "debriding agents" on a prescription, which is a medication rule, not a rule about cutting tissue. (16 CCR § 1399.79 (opens in a new tab); MCA 37-11-106 (opens in a new tab))

PTAs and Sharp Debridement

Most states don't say whether an assistant may debride. Where they do, the line is usually drawn at sharp debridement.

• Barred by statute: Colorado, Utah and Washington. Colorado: a PTA "Shall not perform sharp wound debridement" but "May perform general wound care and nonsharp debridement, including mechanical, autolytic, enzymatic, and maggot, under the supervision of a physical therapist." (C.R.S. § 12-285-210(3), 2024 edition (opens in a new tab)) The board's rule repeats it: "Physical therapist assistants may perform non-selective wound debridement, and limited selective debridement (such as mechanical, autolytic, enzymatic, and maggot), but may not perform sharp wound debridement." (4 CCR 732-1, Rule 1.5 (opens in a new tab)) Utah: a PTA or aide may not "perform the sharp selective debridement component of wound management." (Utah Code § 58-24b-402(2)(d) (opens in a new tab)) Washington: "a physical therapist may not delegate sharp debridement to a physical therapist assistant." (RCW 18.74.010(9)(a) (opens in a new tab)) Its rule adds, "Physical therapists shall not delegate sharp debridement." (WAC 246-915-360 (opens in a new tab))
• Barred by the board: Nebraska. The board's opinion on sharp debridement says, "This does not include physical therapist assistants" (Board opinion (opens in a new tab)), and the rule quoted above makes sharp wound debridement something the PT must provide.
• Only PTs named: Illinois, Louisiana and New Jersey. Illinois says debridement "may only be provided by a physical therapist" (225 ILCS 90/1.2(d) (opens in a new tab)); Louisiana's definition lists "a PT, provisionally licensed PT, or student PT" (La. Admin. Code tit. 46, pt. LIV, § 123 (opens in a new tab)); New Jersey's says removal "by a physical therapist" (P.L.2017, c.121 (opens in a new tab)). None of them says that a PTA may not. Ask your board before treating that wording as a bar or as permission.
• Allowed in limited cases: North Carolina and Virginia. North Carolina's board: "it is not a violation of the North Carolina Physical Therapy Practice Act or Board rules for a physical therapist assistant who is properly trained and appropriately supervised to perform sharp debridement provided that the debridement is strictly treatment. If a continuing evaluation is required during the treatment, then performance by the physical therapist is required, and the determination of whether sharp debridement should be performed is made by the physical therapist." (Position statement 13 (opens in a new tab), reviewed June 5, 2024) Virginia's board: "If, in the professional judgment of the physical therapist responsible for the patient, the physical therapist assistant has the competency, advanced skills, and post entry-level training to perform sharp debridement, it may be delegated to the assistant." (Guidance Document 112-14 (opens in a new tab))
• Aides. Colorado, Oregon and Wyoming bar aides from wound debridement by rule. Colorado's says "Wound care/debridement, dry needling, administration of medications, joint mobilization, and treatment on animals shall not be delegated to a physical therapy aide." (4 CCR 732-1, Rule 1.5 (opens in a new tab))

In home health, a PTA often sees the patient on the visits between PT visits. If the plan of care includes debridement, write down which parts the PTA may do: dressing changes and nonselective care in most states, and sharp debridement only where your state allows it. Our guides on assistant visits and supervisory visits cover the rest of the PTA schedule.

Medicare: What CMS Says

This is federal payment policy, not scope of practice. Medicare pays for what your state lets you do. It doesn't make anything legal that your practice act doesn't allow.

Selective debridement under Part B (CPT 97597 and 97598)

CMS keeps a list of codes that count as therapy. On the 2026 Therapy Code List (opens in a new tab), 97597 and 97598 carry disposition 7. It calls them sometimes therapy codes, but says they are always therapy "when furnished by a therapist and in this situation require the use of a therapy modifier ... in order to indicate the service is furnished under a physical therapy, occupational therapy, or speech-language pathology plan of care." So a PT can bill selective debridement, with the GP modifier, under a PT plan of care.

I found no CMS manual text that says who may perform selective debridement. The closest is the Benefit Policy Manual's rule on dressings, which covers dressings after debridement "irrespective of the type of debridement, as long as the debridement was reasonable and necessary and was performed by a health care professional acting within the scope of his/her legal authority when performing this function." (Medicare Benefit Policy Manual, ch. 15, § 100 (opens in a new tab)) That hands the question back to state law.

The Medicare Administrative Contractors add their own coverage rules in local coverage determinations (LCDs). These apply only in that contractor's states, and they are payment rules, not scope rules. Three I read:

• CGS's Debridement Services LCD: "This LCD does not apply to debridement services performed by physical or occupational therapists. For debridement services performed by physical or occupational therapists, please use CPT codes 97597, 97598 and 97602." (LCD L34032 (opens in a new tab))
• WPS's Wound Care LCD: "Selective debridement should only be done under the specific order of a physician." It also says "Active debridement must be performed under a treatment plan as any other therapy service" and, for therapists, requires a "Practitioner’s order(s) for therapy/wound care services and signed plan of treatment." (LCD L37228 (opens in a new tab))
• Novitas's Wound Care LCD defines selective debridement as "Removal of specific, targeted areas of devitalized or necrotic tissue from a wound along the margin of viable tissue by sharp dissection utilizing scissors, scalpel, curettes, and/or tweezers/forceps," and says "The provider is required to have direct (one-on-one) patient contact when performing active wound care management." (LCD L35125 (opens in a new tab))

If you bill Part B, look up your own contractor's LCD. They differ.

Wound care in home health

The Medicare Benefit Policy Manual's home health chapter answers the PT question directly:

If wound care falls within the auspice of a physical therapist's State Practice Act, then the physical therapist may provide the specific type of wound care services defined in the State Practice Act. However, such visits in this specific situation would be a covered therapy service when there is documentation in the home health record that the skills of a therapist are required to perform the service. The patient’s response to therapy must be documented.

(Medicare Benefit Policy Manual, ch. 7, § 40.2.2(H) (opens in a new tab))

The same chapter treats wound care as a skilled nursing service "when the skills of a licensed nurse are needed to provide safely and effectively the services necessary to treat the illness or injury," and lists "Recently debrided ulcers" among the wounds that usually need a nurse. It also says "the plan of care must contain the specific instructions for the treatment of the wound." (Medicare Benefit Policy Manual, ch. 7, § 40.1.2.8 (opens in a new tab))

In home health, the agency bills a PT's debridement as a PT visit on the home health claim, not as a separate 97597 line. The claims manual says "To report HH visits, the HHA reports one of the following HCPCS codes to represent a visit by each HH care discipline," and for PT that code is G0151, "Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes." (Medicare Claims Processing Manual, ch. 10, § 40.2 (opens in a new tab)) Whoever does it, the wound orders belong in the plan of care, and the visit note has to show why a therapist's skills were needed.

Key Takeaways

• 21 states name debridement in the PT act or rules, and 7 of those name sharp debridement. Four more boards say sharp debridement is in scope.
• In the other 26, nothing names debridement. That leaves it to your board, your training and your plan of care.
• Seven states require an order, referral, authorization, approval or contact with the physician. Washington also requires 20 hours of mentored training or a wound care certification.
• PTAs: barred from sharp debridement in Colorado, Nebraska, Utah and Washington; allowed in limited cases in North Carolina and Virginia; unaddressed almost everywhere else.
• Medicare pays a PT for selective debridement as therapy under a plan of care, and in home health as a PT visit, if your state allows it.
• 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 do sharp wound debridement?

In 25 states the law or the board says a PT may debride wounds. 21 name debridement in the PT practice act or rules, and 7 of those name sharp debridement in so many words: Colorado, Indiana, Louisiana, Nebraska, Texas, Utah and Washington. In Kentucky, New York, South Carolina and Virginia the law is general, but the board has said in writing that sharp debridement is within PT scope. In the other 26 the rules don't name debridement at all. That isn't a ban, but it isn't permission either.

Can a PTA do sharp wound debridement?

In most states the rules don't say. Four bar it: Colorado, Utah and Washington by statute, and Nebraska through a board opinion and a rule that makes sharp wound debridement the PT's job. Illinois, Louisiana and New Jersey word their rules so that only physical therapists are named. Two boards allow it in limited cases: North Carolina, when the PTA is trained and supervised and the debridement is strictly treatment, and Virginia, when the PT judges the PTA competent. The other 42 states say nothing about PTAs and debridement.

Does a physical therapist need a physician order to debride a wound?

In seven states the law sets a condition. Arkansas requires a physician referral. Colorado requires an order from a physician, physician assistant or advanced practice registered nurse. Illinois requires written authorization, Kansas requires approval, and Indiana requires an order or referral for sharp debridement. New Jersey requires you to communicate with the patient's physician or podiatric physician first, and Washington requires a referral or consultation plus proof of training. Virginia's board says sharp debridement needs referral and direction as an invasive procedure.

Can a physical therapist bill CPT 97597 to Medicare?

Yes. CMS lists 97597 and 97598 as sometimes therapy codes. When a therapist furnishes them, they are always therapy and need the GP modifier under a physical therapy plan of care. CMS does not say in its manuals who may perform selective debridement. Its coverage rules point back to state law, and some Medicare contractors add their own conditions in local coverage determinations, such as a physician's order.

Can a physical therapist do wound care in home health under Medicare?

Yes, if your state's practice act allows it. The Medicare Benefit Policy Manual says that if wound care falls within the PT's state practice act, the PT may provide the specific type of wound care the act defines, and the visit is a covered therapy service when the record shows a therapist's skills were needed. In home health the agency bills it as a PT visit on the home health claim, not as a separate 97597 line.

Sources

Every state's rule is linked in the table, to the state's legislature, its official administrative code publisher or its PT board. All were read on November 9, 2026. Board statements are marked as such; they tell you how the board reads its act.

• CMS, Annual Therapy Update (opens in a new tab) and the 2026 Therapy Code List and Dispositions (opens in a new tab): 97597 and 97598, dispositions 6 and 7.
• CMS, Medicare Benefit Policy Manual, ch. 15 (opens in a new tab), § 100 (surgical dressings after debridement).
• CMS, Medicare Benefit Policy Manual, ch. 7 (opens in a new tab), §§ 40.1.2.8 (wound care as skilled nursing) and 40.2.2(H) (wound care by physical therapists).
• CMS, Medicare Claims Processing Manual, ch. 10 (opens in a new tab), § 40.2 (home health visit codes).
• CMS Medicare Coverage Database: CGS LCD L34032, Debridement Services (opens in a new tab); WPS LCD L37228, Wound Care (opens in a new tab); Novitas LCD L35125, Wound Care (opens in a new tab). Text read through CMS's Coverage API.
• For a state's PT board, see our licensure compact tool and the PT compact page.