Supervising a PT or PTA Student: What Your State Requires, in All 50 States and DC

A PT asked me what their state requires when they take a student, after looking at APTA's clinical instructor course. The course is about teaching. The practice act decides who may supervise, and where the supervisor has to be. Here is that answer for all 50 states and DC.

Most states let a student treat only under a licensed physical therapist who is on site, on the premises or physically present. Where they differ is the PTA student: about half let a PTA supervise or teach one, a third name only a PT, and a handful don't say. A few states have no student rule at all beyond a line that exempts students from licensure.

A note on who is writing. I'm an occupational therapist, not a PT, and the founder of Logicly, a scheduling app for home health clinicians. I read each state's statute, administrative code or board rule on the state's own site and linked it below. This isn't legal advice. The rules were checked on November 9, 2026, and your board's current rule is the one that counts.

The Short Answer

• A PT can supervise a PT student in every state that names a supervisor. Only North Carolina's rule says in so many words that a PT may hand a PT student to a PTA. Florida's, Idaho's and Texas's wording doesn't separate PT students from PTA students.
• A PTA can supervise or teach a PTA student in 26 of the 51, by my count. In California, Colorado, Maryland, Missouri and Nevada a PT still has to be on site or keep the supervision. Sixteen name only a PT. Nine leave PTA students out or don't say who supervises.
• On site is the norm. 36 of the 51 require the supervisor on site, on the premises or physically present for at least one kind of student. None of the rules I read uses "line of sight" for students, and none carves out home health.
• No state requires APTA's clinical instructor credential to supervise. Tennessee's rule points to a suggested year of experience; South Carolina says the board approves supervisors on training and experience.
• Medicare adds its own layer. Under Part B the therapist has to be in the room for the whole session. For home health, CMS has no rule for therapy students.

Every State at a Glance

On site here covers the state's own words: on site, on the premises, in the same building or physically present. No specific rule means the practice act and rules don't say where the supervisor has to be; the cited section is the one that covers students.

Who Can Supervise a PTA Student

This is where states split most. Three groups:

A PTA may supervise or teach a PTA student (26). Alabama, California, Colorado, Florida, Idaho, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, North Carolina, Ohio, Oregon, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia and Wisconsin. Washington puts it in the statute: a PTA student is exempt from licensure while "under direct supervision of a licensed physical therapist or licensed physical therapist assistant" (RCW 18.74.150(4)(a) (opens in a new tab)). Louisiana's rule says it plainly: "A PTA can be a clinical instructor for the PTA student" (LAC 46:LIV §337(B) (opens in a new tab)).

The details inside that group differ:

• The PT still supervises, the PTA teaches. In California, "A physical therapist assistant under the supervision of a physical therapist supervisor may perform as a clinical instructor," but a PT supervisor provides the on-site supervision and holds a weekly case conference (16 CCR §1398.52 (opens in a new tab)). Colorado lets a PTA be the clinical instructor, but "immediate supervision ... remains with the physical therapist" (4 CCR 732-1, Rule 1.6(B)(2) (opens in a new tab)). Maryland lets a PTA "participate in the clinical education activities of a physical therapist assistant student if direct supervision of the student is provided by the physical therapist" (COMAR 10.38.03.02B(2)(b) (opens in a new tab)). Missouri's statute and Nevada's statute both require a PT on site.
• A share of the time. Kentucky allows on-site supervision "of which eighty (80) percent may be by a credentialed physical therapist assistant" (201 KAR 22:053 §4(5)(h) (opens in a new tab)). The rest has to be a PT.
• By the PT's choice. Oregon and Wisconsin let the PT delegate the PTA student to a PTA. Wisconsin's PT keeps general supervision of that PTA and full responsibility (PT 5.03 (opens in a new tab)). North Carolina goes further: "A physical therapist may delegate responsibilities to physical therapist assistants, including supervising physical therapist or physical therapist assistant students" (21 NCAC 48C .0102(c) (opens in a new tab)). The PTA then has to be in the same facility, and the PT "immediately available in person or by telecommunication." The statute itself names "a licensed physical therapist" (G.S. 90-270.101(a)(1)); the delegation is the board rule's. It is the only state I read that lets a PTA supervise a PT student in so many words.
• Texas is in this group on the statute's wording, not a board statement. Students are exempt while "being supervised by a license holder under this chapter" (Tex. Occ. Code §453.004(b)(2) (opens in a new tab)), and the chapter licenses PTs and PTAs. The board's FAQ (opens in a new tab) says "Students are specifically exempt from regulation by the Board" and sends clinical instructors to the student's school "about what students may do in a clinical setting and the type of supervision they require."
• New Hampshire's rule and statute disagree. The rule lets "either a physical therapist or physical therapist assistant" supervise a PTA student (Phy 409.03 (opens in a new tab)), while the statute's exemption says "under direct supervision of a physical therapist" (RSA 328-A:8, III(a) (opens in a new tab)). Ask the board before you rely on the rule.

Only a PT is named (16). Alaska, Arizona, Delaware, DC, Georgia, Hawaii, Illinois, Iowa, Michigan, Montana, New Jersey, New York, North Dakota, Pennsylvania, Vermont and Wyoming. Arizona is typical: "A physical therapist student and a physical therapist assistant student must practice under the on-site supervision of a licensed physical therapist" (A.R.S. §32-2043(E) (opens in a new tab)). Montana and Illinois let a PTA supervise aides but name only a PT for students, which reads as a deliberate choice.

No supervisor named, or PTA students left out (9). Connecticut, Kansas, Maine, Oklahoma and Utah exempt students without saying who supervises (Kansas says "a qualified instructor," Utah "qualified faculty, staff, or designee" (Utah Code §58-1-307(1)(b) (opens in a new tab)), Maine only "supervised practice"). South Dakota's physical therapy chapter and rules don't mention students at all, not even an exemption. Arkansas, Indiana and New Mexico exempt PT students but leave PTA students out of the text. In these states I'd follow the school's clinical education agreement and ask the board.

On Site Means On Site

In 36 states, the supervisor has to be there. The words vary, and the strictest is not the one people expect:

• Within the treatment area. Maryland defines direct supervision as a PT "physically present within the treatment area and immediately available" (Health Occ. §13-101(b-1); COMAR 10.38.01.01B(6) (opens in a new tab)). DC's definition is "personally present and immediately available within the treatment area" (17 DCMR §6799.1 (opens in a new tab)). Louisiana requires "continuous supervision" of a PTA student, meaning a supervisor "physically within the same treatment area" (LAC 46:LIV §337 (opens in a new tab)).
• In the building or facility. Oregon: "at all times the supervising physical therapist is in the same building and immediately available" (OAR 848-040-0147(5) (opens in a new tab)). North Dakota writes students into the definition itself: the PT "is onsite and present in the department or facility where services are provided, is immediately available to the individual being supervised, and maintains continued involvement in appropriate aspects of each treatment session in which a student physical therapist or a student physical therapist assistant is involved in components of care" (N.D.C.C. §43-26.1-01(9) (opens in a new tab)).
• On site, not in the room. New York's statute says supervision of a student "shall be on-site supervision and not necessarily direct personal supervision" (Educ. Law §6736(b)(1) (opens in a new tab)).

Three states go further than presence. Michigan's direct supervision means the PT "has direct contact with the patient or client during each visit" (R 338.7121(1)(g) (opens in a new tab)), and New Hampshire's statutory definition says the same for each visit. Minnesota changed its law in 2026: "Telecommunications does not meet the requirement of direct supervision," and a PT supervising a PT student "must have direct contact with the patient during at least every second treatment session by the student physical therapist" (Minn. Stat. §§148.65 (opens in a new tab), 148.706 (opens in a new tab)).

Two states allow video, and only for telehealth. Florida: "Direct Supervision of a student in telehealth occurs when the supervising physical therapist is immediately physically available to visualize, hear, and speak with the patient and the student during the encounter in a synchronous fashion" (r. 64B17-6.001(3)(g) (opens in a new tab)). Colorado's "immediate supervision" allows the PT to be "virtually present synchronously through secure telehealth communications during a telehealth visit" (4 CCR 732-1, Rule 1.4(A)(3) (opens in a new tab)).

No state rule I read uses "line of sight" for students. That phrase comes from Medicare, below.

Two states use words that don't line up. Mississippi's statute requires "direct, on-site supervision," but its own definition of that term describes PT oversight of PTAs "at regular intervals," and the board rule asks for a clinical instructor in "direct control." Nevada's statute requires a PT "present on-site" (NRS 640.120 (opens in a new tab)), while its 2024 rule (LCB File R124-21 (opens in a new tab), not yet in the online code) lets a PTA clinical instructor work under PT supervision available "in person or by telecommunication." In both, plan for a PT on site and ask the board.

What This Means in Home Health

None of the 51 rules I read makes an exception for home health. Where the rule says on site, on the premises or physically present, the clinical instructor goes on the visit. Louisiana spells it out: its student rule applies "in all practice settings," and its definition of practice setting includes "the delivery of home healthcare" (LAC 46:LIV §§123, 337 (opens in a new tab)).

New York is a useful contrast. Its home care exception lets a PT supervise a licensed PTA without being physically present, but the exception covers licensed PTAs, not students. The student rule stays "on-site supervision."

So in most states, a student in home health means two clinicians in the car and one visit on the schedule. That affects your day: a student visit runs longer, and the student's caseload is your caseload. If your agency also uses PTAs, the PTA's 30-day reassessment and supervisory visit rules still apply on top, and the PTA's visits still count under the physical therapy order (which order an assistant works under explains why).

No Student Rule at All

Thirteen states have no specific rule on where the supervisor must be: Alaska, Connecticut, Georgia, Iowa, Kansas, Maine, New Jersey, New Mexico, Oklahoma, South Dakota, Texas, Utah and Vermont. Most of them have a one-line exemption: students may practice under a licensed PT's supervision (Georgia, Iowa, New Jersey), or do work that is "incidental" to their studies (Connecticut, Oklahoma). Delaware and Hawaii say "direct supervision" without defining it for students.

No specific rule doesn't mean anything goes. In these states the general rules still apply: you're responsible for care given under your license, and several states count students in a supervision ratio (Alaska and Vermont cap a PT at three supervisees, students included). Your school's affiliation agreement and Medicare, if the patient has it, will usually ask for more than the state does.

Clinical Instructor Experience and the APTA Course

None of the 51 practice acts and board rules I read requires APTA's Credentialed Clinical Instructor Program to supervise a student. Where the credential appears in a rule, it's for continuing education credit: Nebraska and South Carolina give CE hours for clinical teaching only to credentialed clinical instructors.

Experience rules are rare:

• Tennessee says supervision of PT and PTA students "will be in accordance with the APTA guidelines for clinical education which suggest a minimum of one (1) year of licensed clinical experience prior to functioning as a clinical instructor" (Rule 1150-01-.02(2)(e)-(f) (opens in a new tab)). The word is "suggest."
• South Carolina's statute requires a student's supervisor to be "approved by the board to supervise provisional licensees, students, and aides based on the supervisor's training and work experience" (S.C. Code §40-45-300(E) (opens in a new tab)). I found no published approval process, so ask the board how it applies this.
• Colorado lets a PT student take over PT-only tasks only "under supervision of a clinical instructor actively licensed as a physical therapist, experienced and skilled enough to take on such responsibility" (4 CCR 732-1, Rule 1.5(A)(1)(c) (opens in a new tab)), with no number of years.

So the APTA course is a good idea and often what the school asks for, but in no state I read is it the law.

Co-Signing, Name Tags and Ratios

The smaller duties, where a state has them:

• Co-signing student notes: California (same day), DC, Idaho, Kentucky, Louisiana, Massachusetts, New Hampshire (same day), Ohio, Oregon (same day) and South Carolina. In Ohio, the PT cosigns all student documentation, even an SPTA's note supervised by a PTA. In Nevada, a PTA clinical instructor signs all of the PTA student's documentation.
• How many students: Nevada caps a PT at two students at a time and three supervisees combined. Virginia caps direct supervision at "no more than three individual trainees or students at any one time" (18VAC112-20-100 (opens in a new tab)). Alaska, DC, Hawaii, Michigan and Vermont cap a PT at three supervisees, students included. Mississippi caps a PT at four PTAs and students combined across all sites. Louisiana lets a PTA supervise no more than two PTA students.
• Name tags and titles: California requires the title "physical therapist student" or "physical therapist assistant student" in at least 18-point type (16 CCR §1398.37 (opens in a new tab), §1398.52 (opens in a new tab)). Alabama, DC, Georgia, Hawaii, Idaho, Kentucky, Louisiana, Maine and Ohio also require students to be identified as students, by name tag, title or signing as SPT or SPTA.
• Age: Ohio and West Virginia require students to be at least 18.

What Medicare Adds

Everything above is state law: it decides whether a student may treat and how close you have to be. Medicare is a separate layer that decides whether the visit can be billed. Both apply to the same patient, so follow whichever is stricter.

Part B: the therapist in the room for the whole session

For outpatient therapy billed under Part B, the Medicare Benefit Policy Manual, chapter 15 (opens in a new tab), section 230.B, says:

"Only the services of the therapist can be billed and paid under Medicare Part B. The services performed by a student are not reimbursed even if provided under "line of sight" supervision of the therapist; however, the presence of the student "in the room" does not make the service unbillable."

The manual's examples of what can be billed: the therapist "is present and in the room for the entire session," directing the service and making the skilled judgment; the therapist guides a PT student and a PTA student together and "is not engaged in treating another patient or doing other tasks at the same time"; and the therapist "signs all documentation." The same section says PTAs "are not precluded from serving as clinical instructors for therapy students" when they work within their scope under a PT's direction and supervision.

So under Part B, even a state that allows on-site supervision in the next room doesn't make the student's work billable. The therapist has to be in the room.

Home health under Part A: no therapy student rule

Chapter 7 (opens in a new tab) of the same manual, the home health chapter, has a section on student nurses (40.1.2.14). Their visits "may be covered as skilled nursing care" under "the general supervision of a registered or licensed nurse," and the supervising nurse "need not accompany the student nurse on each visit." There is no matching section for therapy students. I searched chapter 7, the home health conditions of participation and CMS's home health surveyor guidance for "student" and found nothing on PT or PTA students.

What CMS does say is who furnishes covered therapy. Skilled therapy "must require the skills of a qualified therapist" (chapter 7, section 40.2), and a physical therapist and PTA under 42 CFR 484.115 are licensed by the state. A student is neither.

The way I read those together: the student nurse rule doesn't stretch to therapy, so a home health PT visit should be the licensed PT's or PTA's visit, with the student taking part while you're there and directing it. That is my reading, not a CMS statement. Check your agency's policy, and your Medicare Administrative Contractor if your agency wants it in writing.

Key Takeaways

• A PT can supervise a PT student in every state that names a supervisor. Only North Carolina's rule lets the PT hand a PT student to a PTA.
• A PTA can supervise or teach a PTA student in 26 of the 51, sometimes only with a PT on site or for part of the time. Sixteen name only a PT, and nine leave PTA students out or don't say who supervises.
• In 36 of the 51, the supervisor has to be on site for at least one kind of student, and no state exempts home health. In those states, the clinical instructor goes on the home visit.
• No state requires APTA's clinical instructor credential to supervise. Tennessee points to a suggested year of experience.
• Medicare Part B pays only for the therapist's service, with the therapist in the room for the whole session. CMS has no home health rule for therapy students.
• This isn't legal advice. The rules were checked on November 9, 2026, and your board's current rule is the one that counts.

Frequently asked questions

Can a PTA supervise a PTA student?

In about half the states, yes. By my count, 26 of the 51 jurisdictions let a PTA supervise or teach a PTA student in some form, among them Washington by statute and Ohio and Virginia by board rule. In five of them (California, Colorado, Maryland, Missouri and Nevada) a PT still has to be on site or keep the supervision. Sixteen name only a PT, and nine either leave PTA students out or don't say who supervises. Check your state's row in the table.

Does the clinical instructor have to be on site with a PT student?

In most states, yes. By my count, 36 of the 51 require the supervisor to be on site, on the premises or physically present, for at least one kind of student. Thirteen have no specific rule on where the supervisor must be, and Delaware and Hawaii say direct supervision without defining it for students. None of the rules I read uses line of sight for students, and none makes an exception for home health. Florida and Colorado allow live video only during a telehealth visit.

Do I need APTA's clinical instructor credential to supervise a student?

Not under any of the state rules I read. No practice act or board rule makes the APTA Credentialed Clinical Instructor Program a condition of supervising a student. Some states, Nebraska and South Carolina among them, ask for the credential only if you want continuing education credit for clinical teaching. Tennessee's rule points to APTA guidelines that suggest one year of licensed clinical experience before you act as a clinical instructor. Your student's school may ask for more.

Can a PT student see a home health patient without the PT there?

Not in most states. Where the rule says on site, on the premises or physically present, the supervising therapist has to be in the home for the visit, and none of the rules I read carves out home health. Louisiana's rule applies in all practice settings and names home health among them. On the Medicare side, CMS has a home health rule for student nurses but none for therapy students, so plan each visit as the licensed therapist's visit.

Can Medicare be billed for services a PT student provides?

Under Part B, only the therapist's services are billed. The Medicare Benefit Policy Manual, chapter 15, section 230.B, says services performed by a student are not reimbursed even under line of sight supervision; the therapist has to be in the room for the whole session, directing it, and signs the documentation. For home health under Part A, CMS has no therapy student rule, and a covered therapy visit has to need the skills of a qualified therapist.

Sources

• Each state's statute, administrative code or board rule is linked in the table and the sections above, read on the state's own site (its legislature, its official code publisher or the PT board) on November 9, 2026.
• CMS, Medicare Benefit Policy Manual, Chapter 15 (opens in a new tab), section 230.B: therapy students under Part B; PTAs as clinical instructors.
• CMS, Medicare Benefit Policy Manual, Chapter 7 (opens in a new tab), section 40.1.2.14 (student nurse visits) and section 40.2 (skilled therapy services).
• 42 CFR 484.115 (opens in a new tab): who counts as a physical therapist and a physical therapist assistant in home health.
• 42 CFR 409.44(c) (opens in a new tab): home health therapy coverage.
• CMS, State Operations Manual, Appendix B (opens in a new tab): surveyor guidance for home health agencies (no therapy student guidance).
• Related on this site: supervisory visit requirements in home health, which order an assistant works under, scheduling for home health PTs.