How Closely Does a PT Have to Supervise a PTA? The Rules in All 50 States and DC

In every state, an experienced physical therapist assistant can treat a patient without the PT in the room, and in nearly every state without the PT in the building. What changes at the state line is how reachable the PT has to be, how often the PT has to see the patient (from every 6 visits or 14 days to every 60 days), and how many PTAs one PT may cover (from 2 to 6, or no limit at all). Seven states have a rule written for home health, and each one sets a schedule: a PT visit, a plan review or, in Georgia, a weekly meeting with the PTA.

This article goes through every state for PTs and PTAs: the supervision level, the home health or off-site rule where there is one, how often the PT must see the patient, the ratio, and any extra rule for new graduates, each with the rule's own words and a link to it. What a PTA may not do, such as evaluations, reassessments and discharge, is a separate question, covered in can a PTA do a reassessment or discharge. 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

• The PT rarely has to be on site. In nearly every state the PT only has to be reachable, by phone, video or "telecommunication." A few put a clock on it: Arizona 15 minutes, Arkansas 30 minutes, Hawaii able to get there within two hours. The exceptions are Pennsylvania (on-premises by default), New York outside home care, and Delaware for a PTA's first year.
• 36 jurisdictions set a schedule for the PT to see or reassess the patient. Thirty days is the most common. The tightest are New Jersey (6 visits or 14 days), Pennsylvania home health (7 visits or 14 days) and Mississippi (6th treatment day or 14 days). The loosest reach 60 days, in Idaho, North Carolina, South Carolina, Texas and Oklahoma home health. Fourteen states set no schedule, and New Mexico requires a plan-of-care review every 30 days but no visit.
• Seven states have a rule written for home health: Georgia, Massachusetts, Nebraska, New York, Oklahoma, Pennsylvania and Wyoming.
• 36 jurisdictions cap the number of PTAs per PT, from 2 to 6. Fifteen set no number.
• Five states tie off-site supervision to experience: Arizona, Delaware, Nevada, New York and Pennsylvania. And by my count 19 require on-site, direct or daily in-person supervision for a PTA working on a temporary license or permit.
• Medicare adds its own floor in home health: a qualified therapist has to treat and reassess the patient at least every 30 days. When your state's rule is stricter, you follow your state.

Every State at a Glance

Not set means the practice act and rules give no number for that point; None set means no ratio. Each citation links to the official text I read, and the label after it says whether it's a statute, a rule or a board document.

The Seven States With a Home Health Rule

These are the states whose rules name home health, home care or the patient's home when they set PTA supervision.

• Georgia, a weekly meeting. "The licensed physical therapist in the home health setting responsible for the patient shall supervise the physical therapist assistant working with the patient and shall: (a) perform the initial patient evaluation to establish a physical therapy diagnosis, treatment goals, frequency, duration, and plan of care; (b) meet with the assistant no less than once weekly to review all patients being treated; (c) document all meetings with the assistant and subsequent decisions; (d) be available to the assistant at all times for advice, assistance, and instructions." (Ga. Comp. R. & Regs. 490-5-.01(4) (opens in a new tab))
• Massachusetts, a 30-day review. The PT of record's formal review of the plan of care must be done "within the following timeframes: (a) Acute care: at least every seven to ten days. (b) Outpatient, rehabilitation, home health, skilled nursing facility: at least every 30 days." (259 CMR 5.03(2) (opens in a new tab))
• Nebraska, home health as a satellite clinic. Home health is on the rule's list of satellite clinics where a PT may supervise a PTA under general supervision, and there "A supervisory visit with the physical therapist will be made every 30 days or at a higher frequency if warranted." The visit "must include: (1) Direct patient contact for the purpose of reevaluation or re-examination of patient status; (2) A review of the plan of care with revision and or termination of treatment as warranted". (172 NAC 137-008.01 (opens in a new tab))
• New York, two years of experience and a joint visit. In a home care setting, "continuous supervision of a licensed physical therapist assistant, who has had direct clinical experience for a period of not less than two years, by a licensed physical therapist shall not be construed as requiring the physical presence of such licensed physical therapist at the time and place where such services are performed." Continuous supervision includes "an initial joint visit with the patient by the supervising licensed physical therapist and the licensed physical therapist assistant" and "periodic treatment and evaluation of the patient by the supervising licensed physical therapist, as indicated in the plan of care and as determined in accordance with patient need, but in no instance shall the interval between such treatment exceed every six patient visits or thirty days, whichever occurs first". The home care ratio "shall not exceed the ratio of two physical therapist assistants to one licensed physical therapist." The law marks this paragraph "NB Repealed June 30, 2030". (N.Y. Educ. Law §6738 (opens in a new tab))
• Oklahoma, 60 days with a 30-day consult. The PT of record re-examines the patient "every 60 days in home health settings with documented case consultation no less frequently than every 30 days". Outside home health, general supervision still means a PT who "every three months will provide a minimum of one (1) co-treatment of face to face, real time interaction with each physical therapist assistant providing services with his/her patients." (Okla. Admin. Code 435:20-1-1, 435:20-7-1 (opens in a new tab))
• Pennsylvania, every 7 visits or 14 days. "For home health care, a licensed physical therapist shall make an onsite visit and actively participate in the treatment of the patient at least every seven patient visits or every 14 days, whichever occurs first. For purposes of this paragraph, active participation includes examination of the patient. Multiple visits on a single date constitute only a single patient visit in determining whether the licensed physical therapist is required to make an onsite visit." (49 Pa. Code §40.173(c)(6) (opens in a new tab))
• Wyoming, a first-visit conference and a 30-day visit. "When components of a patient’s treatment are delegated to a physical therapist assistant in home health, long-term care, or school settings: ... (A) The physical therapist must be accessible in person or by telecommunication to the physical therapist assistant at all times while the physical therapist assistant is treating the patient; (B) A joint visit by the physical therapist and physical therapist assistant or a conference between the physical therapist and physical therapist assistant must be made prior to or on the first physical therapist assistant visit to the patient; (C) At least once every thirty (30) calendar days the physical therapist must visit the patient". "The visit shall be on-site or virtually through a live audio and video connection". (Wyo. Bd. of PT Rules ch. 7, §5(b)(vi) (opens in a new tab))

North Dakota's rule isn't written for home health, but it reads like it: a joint visit or conference "prior to or on the first physical therapist assistant visit," then "At least once after a sixth physical therapist assistant visit or at least once every thirty calendar days, whichever occurs first, a physical therapist must visit the patient." (N.D. Admin. Code §61.5-05-01-02 (opens in a new tab))

The Tightest Visit Schedules

Most states that set a schedule land on 30 days. Four are much tighter, and they matter most in home health, where a PTA may see a patient three times a week.

• New Jersey. Under general supervision the PT must "Make an on-site visit and participate in the treatment of the patient at least every six patient visits or every 14 days, whichever occurs first." The PT also has to make an on-site visit when the PTA asks for a reexamination, when the plan of care needs to change, before discharge and when the patient's medical status changes. (N.J.A.C. 13:39A-7.2(c) (opens in a new tab))
• Mississippi. The PTA works under "direct, on-site supervision," which the rules define as "face-to-face oversight by a licensed physical therapist at regular intervals"; "Face-to-face" means "within each other’s sight or presence at regular intervals"; and "Regular intervals" means "every sixth treatment day or fourteenth calendar day, whichever comes first." (30 Miss. Admin. Code Pt. 3101, R. 1.3 (opens in a new tab))
• Nevada. The supervising PT "Shall provide the required treatment and reevaluate the patient not less than every seventh day of treatment or within 21 days, whichever occurs first." (NAC 640.592 (opens in a new tab))
• Delaware. For a PTA with a year or more of experience, the PT "must see the patient, in person or by telehealth, at least once every sixth treatment day, and the Physical Therapist Assistant must receive face to face supervision, in person or by telehealth, at least once every twelfth treatment day." (24 Del. Admin. Code 2600-1.2.3 (opens in a new tab))

Pennsylvania's home health rule (every 7 visits or 14 days) belongs on this list too.

When Experience Changes the Rule

Five states let a PTA work away from the PT only after some time in practice. For a home health agency hiring a new graduate, these are the rules to read first.

• New York: two years of direct clinical experience before a PTA can work in home care without the PT present (above).
• Pennsylvania: off-site work needs a certificate of authority, and the applicant must show "at least 2,000 hours of experience providing patient-related acts and services" under a PT's supervision. (49 Pa. Code §40.165 (opens in a new tab))
• Arizona: before a PT delegates under general supervision, the PTA must have "completed at least 2,000 hours of experience as a physical therapist assistant working with patients under onsite supervision." (A.A.C. R4-24-303(D) (opens in a new tab))
• Delaware: for a PTA "with less than 1 year experience," the PT "shall be on the premises at all times and see each patient." (24 Del. Admin. Code 2600-1.2.2 (opens in a new tab))
• Nevada: the PT "Must be accessible for communication by telephone during the time that the physical therapist assistant is treating the patient, if the physical therapist assistant has at least 2,000 hours of experience as a physical therapist assistant." Nevada's 2024 amendment redefined supervision as a PT "available in person or by telecommunication while the treatment is performed" but left the 2,000-hour wording in place, so a newer PTA should ask the board. (NAC 640.592 (opens in a new tab); R124-21 (opens in a new tab))

A PTA who hasn't passed the exam yet is a different case. By my count, 19 jurisdictions put a PTA on a temporary license, permit or license-pending status under on-site, direct or daily in-person supervision, and California adds "A supervising physical therapist will conduct a weekly case conference and document it in the patient record." (16 CCR §1399.12 (opens in a new tab)) In practice that keeps a new graduate out of solo home visits until the license comes through.

How Reachable the PT Has to Be

Most rules say the PT must be available by telecommunication. A few say how fast, or how far.

• Arizona: the PT must "Respond to a communication from the physical therapist assistant within 15 minutes" and "Go to the location at which and on the same day that the physical therapist assistant provides a selected treatment intervention if the physical therapist, after consultation with the physical therapist assistant, determines that going to the location is in the best interest of the patient". (A.A.C. R4-24-303(F) (opens in a new tab))
• Arkansas: "“Readily available for consultation” means the ability to be reached in person or by telecommunications within thirty (30) minutes". (17 CAR §175-101 (opens in a new tab))
• Hawaii: "Telecommunications accessibility at all times when the supervising physical therapist is not on site and the ability to be on site within two hours if the supervising physical therapist's physical presence is needed." (Haw. Admin. R. §16-110-4(b)(8) (opens in a new tab))
• Florida: outside hospitals and acute care, "the physical therapist shall be accessible at all times by telecommunication and shall be within the same geographic location as the assistant." (Fla. Admin. Code r. 64B17-6.001(5)(c) (opens in a new tab))
• West Virginia: the PT must be reachable at all times and "available to make a joint onsite visit or telehealth session with the physical therapist assistant within 24 hours as prudent practice indicates." (W. Va. Code R. §16-1-10.2.1 (opens in a new tab))
• Wisconsin: besides staying reachable, the PT must "Have direct face-to-face contact with the physical therapist assistant at least every 14 calendar days," and "Audio-only telephone, email messages, text messages, facsimile transmission, mail or parcel service are not considered acceptable electronic communications." (Wis. Admin. Code PT 5.01(2)(b) (opens in a new tab))
• Kentucky: the board's FAQ says a PT can't supervise a PTA from another state: "Supervision is part of the practice of Physical Therapy in the Commonwealth of Kentucky and as such has to be performed in the Commonwealth of KY." (Kentucky Board of Physical Therapy FAQ (opens in a new tab), board FAQ)

Where the Rules Changed or Disagree

• Louisiana: the statute, last amended in 2025, says the PT must "treat and reassess the patient at least every twelfth treatment day or every thirty days and for his final treatment session, when feasible," and opens that list with "Notwithstanding any provision of law or rule to the contrary." (La. R.S. 37:2418(F)(2) (opens in a new tab)) The board's rule, last amended in 2021, still says "treat and reassess the patient at least every sixth treatment day or every 30 days, whichever occurs first," with a PT-PTA conference on the same schedule. (La. Admin. Code tit. 46, pt. LIV, §333 (opens in a new tab)) Keeping to the rule's 6th-day schedule meets both; ask the board which one it enforces.
• District of Columbia: the rule still says "A physical therapy assistant may perform the following functions under the direct supervision of a physical therapist," and DC defines direct supervision as a PT "personally present and immediately available within the treatment area". (17 DCMR §6712.2 (opens in a new tab); §6799.1 (opens in a new tab)) In December 2024 the board said a PTA "may perform physical therapy functions under the general supervision of a Physical Therapist, rather than the requirement of direct supervision," with the PT reachable "via a synchronous, real-time communication device for the duration of the time that the supervisee is practicing," until the rule is updated. (Policy Statement 24-002 (opens in a new tab), board statement)
• Minnesota (2026): a 2026 law replaced on-site observation every six sessions with this: the PT must, "at least every six treatment sessions that the physical therapist assistant provides services," "observe a portion of the patient treatment session with the physical therapist assistant, either in person or remotely via telehealth". (Minn. Stat. §148.706, subd. 3 (opens in a new tab))
• Oregon (2025): the reexamination rule now reads "When the interval since a patient's last visit is 30 days or longer". (OAR 848-040-0155 (opens in a new tab)) The board's March 2025 amendment removed an older line that required reexamination when a PT hadn't treated the patient in 30 days. (Filed order OBPT 1-2025 (opens in a new tab), rule)
• Washington: watch the wording. Reevaluation is due at "The later of every fifth visit or every thirty days if a physical therapist has not treated the patient for any of the five visits or within the thirty days". (RCW 18.74.180(2) (opens in a new tab)) That is "later," not "whichever comes first," so Medicare's 30-day rule will usually be the stricter one for a home health patient.

What Medicare Requires

Federal rules sit on top of state law. They don't replace it.

Home health: the 30-day reassessment

Medicare covers home health therapy only when the services can be performed "only by a qualified physical therapist or by a qualified physical therapy assistant under the supervision of a qualified physical therapist". (42 CFR 409.44(c)(1)(ii) (opens in a new tab)) The PT then has to come back:

At least every 30 calendar days a qualified therapist (instead of an assistant) must provide the needed therapy service and functionally reassess the patient in accordance with § 409.44(c)(2)(i)(A).

If that slips, "therapy visits for the therapy discipline(s) not in compliance with these policies will not be covered until the following conditions are met," starting with the therapist's reassessment. (42 CFR 409.44(c)(2)(i)(B)-(C) (opens in a new tab)) Neither this section nor the personnel rule below says how close the PT has to be during the PTA's own visits; that part comes from your state. Supervisory visit requirements in home health walks through the federal side in more depth, and which order an assistant's visits fall under covers how PTA visits count against the PT order.

Who counts as a qualified PTA

For a home health agency, a physical therapist assistant is "A person who is licensed, registered or certified as a physical therapist assistant, if applicable, by the state in which practicing, unless licensure does not apply and meets one of the following requirements". The usual route is to have "Graduated from a physical therapist assistant curriculum approved by the Commission on Accreditation in Physical Therapy Education" and "Passed a national examination for physical therapist assistants." (42 CFR 484.115(i) (opens in a new tab)) A PTA on a temporary license or permit is a state question first: if your state requires on-site supervision for that license, that's the rule for the home visit.

Outpatient private practice: general supervision since 2025

Until 2025, Medicare made PTs in private practice directly supervise their PTAs, which meant being in the office suite or the patient's home. The CY 2025 Physician Fee Schedule final rule, effective January 1, 2025, changed that "to allow for general supervision of OTAs and PTAs by OTPPs and PTPPs, when the OTAs and PTAs are furnishing outpatient occupational and physical therapy services, respectively." Under general supervision, "the OTPP/PTPP need not be present in the treatment location or immediately available." CMS said this would "align with the currently required general supervision of PTAs/OTAs by PTs and OTs who work for Medicare institutional providers, such as rehabilitation agencies, outpatient hospitals, and SNFs," and it was plain about state law: "For the States with more restrictive supervision levels, such as direct supervision, Medicare-covered therapy services provided in those States are required to be furnished in compliance with State law." (CY 2025 PFS final rule, 89 FR 97710 (opens in a new tab))

The current regulation, as of November 2026:

Physical therapy services may be performed by a physical therapist assistant under the general supervision of the physical therapist in private practice; services performed by an unenrolled physical therapist must be under the direct supervision of the physical therapist.

(42 CFR 410.60(c)(2) (opens in a new tab)) The occupational therapy rule says the same for OTAs: "Occupational therapy services may be performed by an occupational therapy assistant under the general supervision of the occupational therapist in private practice". (42 CFR 410.59(c)(2) (opens in a new tab)) I checked the CY 2027 fee schedule and home health final rules, both published November 9, 2026; neither changes these sections.

When your state's rule is stricter than Medicare's, you follow the stricter one. A Pennsylvania home health PT, for example, meets Medicare's 30-day rule only by also meeting the state's 7-visit-or-14-day rule, which comes due first.

Key Takeaways

• In almost every state the PT doesn't have to be on site, only reachable. Pennsylvania, New York (outside home care) and Delaware (first year) are the main exceptions.
• 36 jurisdictions set a schedule for the PT to see or reassess the patient, most often 30 days, as tight as 14 days in New Jersey, Mississippi and Pennsylvania home health.
• Seven states have a home health rule: Georgia, Massachusetts, Nebraska, New York, Oklahoma, Pennsylvania and Wyoming.
• 36 cap PTAs per PT, from 2 to 6, and several count every location you cover.
• New graduates: check experience rules in Arizona, Delaware, Nevada, New York and Pennsylvania, and expect on-site supervision while on a temporary license.
• Medicare home health adds a 30-day reassessment; when the state rule is stricter, follow the state.
• 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

How often does a PT have to see a patient when a PTA is treating in home health?

Medicare requires a qualified therapist to treat and functionally reassess the patient at least every 30 calendar days. On top of that, 36 jurisdictions set their own schedule, and some are much tighter: New Jersey every 6 visits or 14 days, Pennsylvania's home health rule every 7 visits or 14 days, Mississippi every 6th treatment day or 14 days, and Nevada every 7th treatment day or 21 days. Fourteen states set no schedule. When the state rule is stricter than Medicare's, you follow the state rule.

Does the PT have to be on site when a PTA treats?

In most states, no. An experienced PTA can treat without the PT in the building as long as the PT can be reached, usually by phone or video. The main exceptions are Pennsylvania, where the default is on-premises supervision until the PTA earns a certificate for off-site work; New York outside home care and a few other settings; and Delaware for a PTA with under a year of experience. A PTA working on a temporary license or permit while waiting to pass the exam usually needs a PT on site.

How many PTAs can one PT supervise?

It depends on the state. By my count, 36 jurisdictions set a number, from 2 to 6: ten cap it at 2, thirteen at 3, eleven at 4, Wyoming at 5 personnel and Louisiana at 6 individuals. Several count every location you cover, not just one clinic, and New York drops its limit from 4 to 2 in home care. Fifteen set no number and leave it to the PT's judgment.

Can a new graduate PTA work in home health?

Sometimes, but check your state first. New York lets a PTA work in home care without the PT present only after two years of clinical experience. Pennsylvania requires 2,000 hours before a PTA can work off-site, Arizona requires 2,000 hours under on-site supervision before general supervision, Delaware keeps the PT on the premises for a PTA's first year, and Nevada ties phone-only supervision to 2,000 hours. A PTA still on a temporary license or permit usually needs on-site supervision, which rules out solo home visits.

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.

• 42 CFR 409.44 (opens in a new tab), 484.115 (opens in a new tab), 410.59 (opens in a new tab) and 410.60 (opens in a new tab), eCFR, up to date as of November 5, 2026.
• CMS, CY 2025 Physician Fee Schedule final rule (opens in a new tab), 89 FR 97710 (December 9, 2024), section on supervision of outpatient therapy services in private practices.
• Board statements and FAQs cited in the table and sections: District of Columbia Board of Physical Therapy Policy Statement 24-002; Idaho Physical Therapy Board Guidance Document on Supervision (November 18, 2025); Kentucky Board of Physical Therapy FAQ; Mississippi State Board of Physical Therapy position statement on PTA supervision (opens in a new tab) (October 19, 2017), which says "the supervising physical therapist of record may only supervise a total of four (4) physical therapist assistants" across facilities; New York State Education Department PTA practice FAQ (opens in a new tab), which says "In a home care services setting, a physical therapist may supervise no more than two physical therapist assistants."