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Practice Acts36 min read

Can You Treat Your Own Family as a PT, OT or SLP? The Rules in Every State

Can a PT, OT or SLP treat a family member or friend? No state bans it, and 11 write in a spouse. Every state's rule, quoted and linked, plus Medicare's limit.

Reza

Founder, OTR/L·

In every state I checked, the practice acts and board rules for PTs, OTs and speech-language pathologists don't forbid treating your own family or friends. No state names a parent, child, sibling or friend as someone you may not treat. Eleven states mention a spouse or partner, mostly to carve them out of the sexual-misconduct ban, and Wyoming lets an OT treat a spouse only without third-party payment. The real limits are the general ones: dual-relationship and conflict-of-interest rules, the professional codes many states adopt, and who pays.

This article goes through every state for all three professions: what the rules say, the rule they come from with a link to the official source, and the exact words of every rule that touches on treating someone close to you. I'm an occupational therapist, not a PT or an SLP, so for those professions 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

  • No state bans it. In all 51 jurisdictions, none of the PT, OT or SLP rules I read bars treating a family member, relative, household member or friend. (I couldn't read New Jersey's SLP rules; its other rules and the SLP statute say nothing against it.)
  • One board names relatives. New York's PT board lists "treating patients/clients to whom you are related by blood or legal ties" as a relationship that may raise boundary questions (practice alert (opens in a new tab)). That's guidance, not a rule.
  • 11 states write in a spouse or partner: Arkansas (SLP), California (all three), Idaho (PT, SLP), Indiana (all three), New Hampshire (SLP), New Jersey (PT, OT), North Dakota (PT), Ohio (PT, OT), Pennsylvania (PT), Washington (all three) and Wyoming (OT). Most carve the spouse out of a sexual-misconduct ban. Three go further: New Jersey says nothing stops you treating a spouse, Washington's rules don't prohibit care for someone you already had a relationship with, and Wyoming allows it for OTs only without third-party compensation.
  • 8 more states reach it without naming family, through their own dual-relationship or conflict-of-interest rules: Illinois (OT), Kentucky (SLP), Louisiana (SLP), Maryland (OT), Montana (all three), South Carolina (OT), Texas (OT) and West Virginia (OT).
  • Adopted national codes add more. 15 jurisdictions adopt AOTA's code by reference for OTs and 7 adopt ASHA's for SLPs. AOTA's code bars dual relationships that jeopardize objectivity, and the current ASHA code covers personal relationships that could sway you.
  • Everywhere else, no specific rule. The board would use its general unprofessional-conduct or ethics ground, cited in the table.
  • Payment is a separate question. Medicare won't pay charges imposed by an immediate relative or household member. For a home health agency it depends on who owns the agency. See the Medicare section.

Every State at a Glance

No specific rule means the act, the board rules and the board's published statements say nothing specific about treating family or friends, and the citation is the general ground the board would use. Spouse carve-out means a sexual-misconduct rule excludes the clinician's spouse or partner. Not specific means a rule on dual relationships or personal conflicts whose words reach it without naming family. Each citation links to the official source I read.

State PT / PTA OT / OTA SLP Rule(s)
Alabama No specific rule No specific rule No specific rule; general conflict-of-interest rule PT: r. 700-X-3-.02 (opens in a new tab) (rule); OT: r. 625-X-9-.02 (opens in a new tab) (rule); SLP: r. 870-X-6-.04 (opens in a new tab) (rule)
Alaska No specific rule No specific rule No specific rule PT/OT: AS 08.84.120 (opens in a new tab) (statute); SLP: AS 08.11.085 (opens in a new tab) (statute)
Arizona No specific rule No specific rule No specific rule PT: A.R.S. § 32-2044 (opens in a new tab) (statute); OT: A.R.S. § 32-3401 (opens in a new tab) (statute); SLP: A.R.S. § 36-1901(27) (opens in a new tab) (statute)
Arkansas No specific rule No specific rule; adopts the current AOTA code Spouse carve-out: the sex ban excludes "a spouse or other individual with whom a prior consensual relationship exists"; conflict rule covers "personal, financial, or other considerations" PT: 17 CAR § 175-108 (opens in a new tab) (rule); OT: 17 CAR § 140-407 (opens in a new tab) (rule); SLP: ABESPA Rule §§ 8.3(B), 8.4(M) (opens in a new tab) (rule)
California Spouse carve-out (all health licensees): the sex-misconduct ban "shall not apply to consensual sexual contact between a licensee and his or her spouse or person in an equivalent domestic relationship" Spouse carve-out for a licensee who "provides occupational therapy services to his or her spouse, registered domestic partner"; must avoid relationships that "interfere with professional judgment and objectivity" Spouse carve-out (same law as PT) PT, SLP: Cal. Bus. & Prof. Code § 726(b) (opens in a new tab) (statute); OT: 16 CCR § 4170(b)(2)-(3) (opens in a new tab) (rule)
Colorado No specific rule No specific rule No specific rule PT: C.R.S. § 12-285-120 (opens in a new tab) (statute); OT: C.R.S. § 12-270-114 (opens in a new tab) (statute); SLP: C.R.S. § 12-305-112 (opens in a new tab) (statute)
Connecticut No specific rule No specific rule No specific rule PT: Conn. Gen. Stat. § 20-73a (opens in a new tab) (statute); OT: § 20-74g (opens in a new tab) (statute); SLP: § 20-414 (opens in a new tab) (statute)
Delaware No specific rule No specific rule No specific rule; general conflict-of-interest rule PT: 24 Del. Admin. Code 2600-12.8 (opens in a new tab) (rule); OT: 24 Del. C. § 2015 (opens in a new tab) (statute); SLP: 24 Del. Admin. Code 3700-9.3 (opens in a new tab) (rule)
District of Columbia No specific rule No specific rule; adopts the AOTA code as amended No specific rule; adopts the current ASHA code All: D.C. Code § 3-1205.14 (opens in a new tab) (statute); OT: 17 DCMR § 6316.1 (opens in a new tab) (rule); SLP: 17 DCMR § 7913.1 (opens in a new tab) (rule)
Florida No specific rule No specific rule No specific rule PT: Fla. Stat. § 486.125 (opens in a new tab) (statute); OT: § 468.217 (opens in a new tab) (statute); SLP: § 468.1295 (opens in a new tab) (statute)
Georgia No specific rule No specific rule No specific rule; general conflict-of-interest rule PT: Ga. Comp. R. & Regs. 490-9-.02 (opens in a new tab) (rule); OT: 671-4-.01 (opens in a new tab) (rule); SLP: 609-4-.03(14) (opens in a new tab) (rule)
Hawaii No specific rule No specific rule No specific rule PT: Haw. Code R. § 16-110-50 (opens in a new tab) (rule); OT: HRS § 457G-7 (opens in a new tab) (statute); SLP: Haw. Code R. § 16-100-48 (opens in a new tab) (rule)
Idaho Spouse carve-out: the sex ban "shall not apply to sexual contact between a physical therapist or physical therapist assistant and the physical therapist’s or physical therapist assistant’s spouse or a person in a domestic relationship who is also a patient" No specific rule Spouse carve-out: the ban "shall not apply to sexual contact between a licensee and such licensee’s spouse or a person in a domestic relationship with the licensee who is also a client" PT: Idaho Code § 54-2219(10)(b) (opens in a new tab) (statute); OT: § 54-3718 (opens in a new tab) (statute); SLP: § 54-2923(14)(b) (opens in a new tab) (statute)
Illinois No specific rule Not specific. "Occupational therapy practitioners shall avoid those relationships or activities that interfere with professional judgment and objectivity." Also adopts the AOTA 2015 code No specific rule; adopts the 2016 ASHA code PT: 68 Ill. Adm. Code 1340.65 (opens in a new tab) (rule); OT: 1315.165(b)(2) (opens in a new tab) (rule); SLP: 1465.95(p) (opens in a new tab) (rule)
Indiana Spouse carve-out (all health licensees): "A practitioner who provides health care services to the practitioner's spouse is not subject to disciplinary action under subsection (a)(11)", the patient-sex ground Spouse carve-out (same law) Spouse carve-out (same law) All: IC 25-1-9-4(b) (opens in a new tab) (statute)
Iowa No specific rule No specific rule No specific rule PT: Iowa Admin. Code 481—ch. 802 (opens in a new tab) (rule); OT: ch. 807 (opens in a new tab) (rule); SLP: ch. 743 (opens in a new tab) (rule)
Kansas No specific rule No specific rule No specific rule PT: K.A.R. 100-29-12 (opens in a new tab) (rule); OT: K.A.R. 100-54-5 (opens in a new tab) (rule); SLP: K.A.R. 28-61-11 (opens in a new tab) (rule)
Kentucky No specific rule No specific rule Not specific. No "dual relationship with a patient, including a social, business, or personal relationship" that may impair judgment; if one "cannot be avoided," take precautions PT: KRS 327.070 (opens in a new tab) (statute); OT: 201 KAR 28:140 (opens in a new tab) (rule); SLP: 201 KAR 17:041, § 1(2)(b) (opens in a new tab) (rule)
Louisiana No specific rule No specific rule; adopts the most current AOTA code Not specific. Conflict rule: "personal, financial, or other considerations have the potential to influence or compromise professional judgment and objectivity" PT: La. Admin. Code tit. 46, pt. LIV, § 345 (opens in a new tab) (rule); OT: pt. XLV, § 1903 (opens in a new tab) (rule); SLP: pt. LXXV, § 701 (opens in a new tab) (rule)
Maine No specific rule No specific rule; adopts the AOTA 2020 code No specific rule; general conflict-of-interest rule PT: 02-393 C.M.R. ch. 5 (opens in a new tab) (rule); OT: 02-477 C.M.R. ch. 7 (opens in a new tab) (rule); SLP: 02-643 C.M.R. ch. 11 (opens in a new tab) (rule)
Maryland No specific rule Not specific. "The licensee shall avoid a relationship or an activity with the client that interferes with professional judgment and objectivity." No specific rule PT: COMAR 10.38.02.02 (opens in a new tab) (rule); OT: COMAR 10.46.02.02A (opens in a new tab) (rule); SLP: COMAR 10.41.02.02 (opens in a new tab) (rule)
Massachusetts No specific rule No specific rule; adopts the current AOTA code No specific rule; adopts the ASHA code PT: 259 CMR 5.05 (opens in a new tab) (rule); OT: 259 CMR 3.00 (opens in a new tab) (rule); SLP: 260 CMR 1.01, 1.03(17) (opens in a new tab) (rule)
Michigan No specific rule No specific rule No specific rule All: MCL 333.16221 (opens in a new tab) (statute)
Minnesota No specific rule No specific rule No specific rule PT: Minn. R. 5601.3200 (opens in a new tab) (rule); OT: Minn. Stat. § 148.6448 (opens in a new tab) (statute); SLP: § 148.5195 (opens in a new tab) (statute)
Mississippi No specific rule No specific rule No specific rule PT: 30 Miss. Admin. Code Pt. 3103 (opens in a new tab) (rule); OT: 15 Miss. Admin. Code Pt. 19, Subpt. 60, ch. 8 (opens in a new tab) (rule); SLP: ch. 10, R. 10.8 (opens in a new tab) (rule)
Missouri No specific rule No specific rule; general conflict-of-interest rule No specific rule PT: RSMo § 334.613 (opens in a new tab) (statute); OT: 20 CSR 2205-6.010 (opens in a new tab) (rule); SLP: 20 CSR 2150-4.080 (opens in a new tab) (rule)
Montana Not specific (one rule for all three). Unprofessional conduct includes "maintaining a relationship with a client ... when such relationship ... is likely to impair the licensee’s professional judgment or result in client harm" Same rule Same rule All: Admin. R. Mont. 24.119.2301(1)(e) (opens in a new tab) (rule)
Nebraska No specific rule No specific rule No specific rule PT: 172 NAC 137-012 (opens in a new tab) (rule); OT, SLP: Neb. Rev. Stat. § 38-179 (opens in a new tab) (statute)
Nevada No specific rule No specific rule; adopts the AOTA code (its conflict rule is about working for a relative) No specific rule PT: NAC 640.580 (opens in a new tab) (rule); OT: NAC 640A.205, .225 (opens in a new tab) (rule); SLP: NRS 637B.250 (opens in a new tab) (statute)
New Hampshire No specific rule No specific rule; adopts the AOTA 2015/2020 code Spouse carve-out: sexual misconduct is defined for "a current client who is not a spouse or civil union partner" PT: N.H. Admin. R. Phy 401.17, 405.01 (opens in a new tab) (rule); OT: Occ 502.01 (opens in a new tab) (rule); SLP: Spe 401.01(f) (opens in a new tab) (rule)
New Jersey May treat a spouse: "Nothing in this section shall be construed to prevent a licensee from rendering physical therapy to a spouse," if it meets accepted standards and isn't used to exploit the spouse sexually May treat a spouse: same rule for OT ("rendering occupational therapy to a spouse") Couldn't verify, check with the board. The SLP rules (N.J.A.C. 13:44C) aren't on a free official site I could read; the statute has nothing specific PT: N.J.A.C. 13:39A-3.10(j) (opens in a new tab) (rule); OT: 13:44K-8.5(j) (opens in a new tab) (rule); SLP: board site (opens in a new tab) (board site)
New Mexico No specific rule; general conflict-of-interest rule No specific rule No specific rule; general conflict-of-interest rule PT: 16.20.1 NMAC (opens in a new tab) (rule); OT: 16.15.5.9 NMAC (opens in a new tab) (rule); SLP: 16.26.9 NMAC (opens in a new tab) (rule)
New York Board guidance (not binding): "treating patients/clients to whom you are related by blood or legal ties" may raise "serious questions" about boundaries No specific rule No specific rule PT: PT board practice alert (opens in a new tab) (board statement); All: 8 NYCRR § 29.1 (opens in a new tab) (rule)
North Carolina No specific rule No specific rule; adopts the AOTA code with later editions No specific rule; adopts the ASHA code in effect Jan. 1, 2013 PT: 21 NCAC 48G .0601 (opens in a new tab) (rule); OT: 21 NCAC 38 (opens in a new tab) (rule); SLP: 21 NCAC 64 .0307 (opens in a new tab) (rule)
North Dakota Spouse carve-out: no sexual relationship "while a physical therapist or physical therapist assistant-patient relationship exists, except with a spouse" No specific rule; adopts the AOTA 2015 code No specific rule PT: N.D.C.C. § 43-26.1-13(11)(a) (opens in a new tab) (statute); OT: N.D. Admin. Code 55.5-02-02-01 (opens in a new tab) (rule); SLP: N.D.C.C. § 43-37-13 (opens in a new tab) (statute)
Ohio Spouse carve-out: the sex ban covers "a patient other than the spouse of the physical therapist or physical therapist assistant" Spouse carve-out (same wording for OT); must disclose "personal" affiliations that "may pose a conflict of interest" Not specific. "Dual relationship means when more than one role occurs between the licensee and person(s) being served professionally"; no services "except in a professional relationship" PT: R.C. 4755.47(A)(25) (opens in a new tab) (statute); OT: R.C. 4755.11(A)(25) (opens in a new tab) (statute); OT: Ohio Adm.Code 4755:1-2-01 (opens in a new tab) (rule); SLP: Ohio Adm.Code 4753-9-01 (opens in a new tab) (rule)
Oklahoma No specific rule No specific rule; board code modeled on the AOTA code No specific rule; services only "in a professional relationship" PT: OAC 435:20-5-8 (opens in a new tab) (rule); OT: OAC 435:30-1-10 (opens in a new tab) (rule); SLP: OAC 690:15-1-4 (opens in a new tab) (rule)
Oregon No specific rule No specific rule; adopts the AOTA 2025 code No specific rule PT: OAR 848-045-0020 (opens in a new tab) (rule); OT: OAR 339-010-0020(1)(h) (opens in a new tab) (rule); SLP: OAR 335-005-0015 (opens in a new tab) (rule)
Pennsylvania Spouse carve-out: for the sexual-misconduct rules a patient is "A person, other than the spouse of the physical therapist or physical therapist assistant, who receives professional services" No specific rule; adopts the AOTA 2015 code No specific rule PT: 49 Pa. Code § 40.301 (opens in a new tab) (rule); OT: § 42.24 (opens in a new tab) (rule); SLP: §§ 45.102-45.103 (opens in a new tab) (rule)
Rhode Island No specific rule No specific rule; adopts the AOTA code No specific rule; adopts the 2016 ASHA code PT: 216-RICR-40-05-13 (opens in a new tab) (rule); OT: 216-RICR-40-05-12 (opens in a new tab) (rule); SLP: 216-RICR-40-05-33 (opens in a new tab) (rule)
South Carolina No specific rule Not specific. "Avoid dual relationships, conflicts of interest, and situations in which a practitioner ... is unable to maintain clear professional boundaries or objectivity" No specific rule; general conflict-of-interest rule PT: S.C. Code Regs. 101-15 (opens in a new tab) (rule); OT: 94-10 (opens in a new tab) (rule); SLP: 115-7 (opens in a new tab) (rule)
South Dakota No specific rule No specific rule; may use the 2010 AOTA code as guidance No specific rule PT: ARSD 20:66:02:01 (opens in a new tab) (rule); OT: ARSD 20:64:05:03 (opens in a new tab) (rule); SLP: SDCL 36-37-23 (opens in a new tab) (statute)
Tennessee No specific rule No specific rule; adopts the AOTA 2020 code No specific rule PT: Tenn. Comp. R. & Regs. 1150-01-.14 (opens in a new tab) (rule); OT: ch. 1150-02 (opens in a new tab) (rule); SLP: 1370-01-.13 (opens in a new tab) (rule)
Texas No specific rule Not specific. "Avoid dual relationships, conflicts of interest, and situations in which a practitioner ... is unable to maintain clear professional boundaries or objectivity" No specific rule PT: 22 TAC § 322.4 (opens in a new tab) (rule); OT: 40 TAC § 374.4 (opens in a new tab) (rule); SLP: 16 TAC § 111.155 (opens in a new tab) (rule)
Utah No specific rule No specific rule; adopts the AOTA 2020 code No specific rule; adopts the 2010 ASHA code PT: Utah Admin. Code R156-24b-502 (opens in a new tab) (rule); OT: R156-42a-502 (opens in a new tab) (rule); SLP: R156-41-502 (opens in a new tab) (rule)
Vermont No specific rule No specific rule No specific rule; the statute adopts the ASHA code PT: 26 V.S.A. § 2121 (opens in a new tab) (statute); All: 3 V.S.A. § 129a (opens in a new tab) (statute); SLP: 26 V.S.A. § 4464(b)(16) (opens in a new tab) (statute)
Virginia No specific rule No specific rule No specific rule PT: 18VAC112-20-190 (opens in a new tab) (rule); OT: 18VAC85-80-170 (opens in a new tab) (rule); SLP: 18VAC30-21-160 (opens in a new tab) (rule)
Washington Pre-existing relationship exception: the sex-misconduct rule does not bar care "to a person who is in a preexisting, established personal relationship with the physical therapist or physical therapist assistant where there is no evidence of, or potential for, exploiting the patient or client" Spouse exception: the rule does not prohibit "The provision of occupational therapy services to a spouse or any other person who is in a preexisting, established relationship" Pre-existing relationship exception (same wording as PT, "with the health care provider") PT: WAC 246-915-182(8)(c) (opens in a new tab) (rule); OT: WAC 246-847-210(6)(b) (opens in a new tab) (rule); SLP: WAC 246-828-625(8)(c) (opens in a new tab) (rule)
West Virginia No specific rule Not specific. Practitioners must "Avoid relationships or activities" that interfere with professional judgment and objectivity No specific rule PT: W. Va. Code § 30-20-19 (opens in a new tab) (statute); OT: W. Va. Code R. § 13-6-4.2.b (opens in a new tab) (rule); SLP: W. Va. Code § 30-32-19 (opens in a new tab) (statute)
Wisconsin No specific rule No specific rule No specific rule PT: Wis. Admin. Code PT 7.025 (opens in a new tab) (rule); OT: OT 5.02 (opens in a new tab) (rule); SLP: HAS 6.18 (opens in a new tab) (rule)
Wyoming No specific rule Spouse rule: "The treatment of a spouse or significant other where the relationship is in place prior to the beginning of any patient licensee relationship shall not be unprofessional conduct if treatment is conducted without third party compensation" No specific rule PT: Wyo. Bd. of PT Rules ch. 4, § 3 (opens in a new tab) (rule); OT: W.S. § 33-40-102(a)(vi)(B) (opens in a new tab) (statute); SLP: W.S. § 33-33-305 (opens in a new tab) (statute)

Warning

No specific rule is not the same as go ahead. Every board can discipline under its general unprofessional-conduct ground, and a board looking at care you gave a relative will ask whether your judgment, your records and your billing were what they would have been for a stranger.

The Rules That Mention a Spouse or Partner

Eleven states write the clinician's own spouse or partner into a rule. None of them mentions parents, children, siblings or friends.

Three states say you may treat a spouse or partner

  • New Jersey (PT and OT). The PT rule says: "Nothing in this section shall be construed to prevent a licensee from rendering physical therapy to a spouse, providing that the rendering of such physical therapy is consistent with accepted standards of physical therapy and that the performance of physical therapy is not utilized to exploit the patient spouse for the sexual arousal or sexual gratification of the licensee." A spouse "means the husband, wife or fiancee of the licensee or an individual involved in a long-term committed relationship with the licensee," and a long-term committed relationship is "a relationship which is at least six months in duration." (N.J.A.C. 13:39A-3.10 (opens in a new tab): the board's own rules PDF, in the web archive. The official code is online only in LexisNexis's viewer.)
  • The OT rule is the same: "Nothing in this section shall be construed to prevent a licensee from rendering occupational therapy to a spouse, providing that the rendering of such occupational therapy is consistent with accepted standards of occupational therapy." Its definition of spouse adds a civil union partner. (N.J.A.C. 13:44K-8.5(j) (opens in a new tab), the board's rules PDF in the web archive)
  • Washington (PT, OT and SLP). Each profession's sexual-misconduct rule ends with what it does not prohibit. For PTs and PTAs: "Providing health care services for a legitimate health care purpose to a person who is in a preexisting, established personal relationship with the physical therapist or physical therapist assistant where there is no evidence of, or potential for, exploiting the patient or client." (WAC 246-915-182(8)(c) (opens in a new tab))
  • For OTs and OTAs: "The provision of occupational therapy services to a spouse or any other person who is in a preexisting, established relationship with the occupational therapist or occupational therapy assistant where no evidence of abuse of the occupational therapy practitioner-client relationship exists." (WAC 246-847-210(6)(b) (opens in a new tab))
  • For SLPs, SLPAs and audiologists, the same wording as for PTs, "with the health care provider." (WAC 246-828-625(8)(c) (opens in a new tab))
  • Wyoming (OT). The OT practice act itself defines unprofessional conduct, and says: "The treatment of a spouse or significant other where the relationship is in place prior to the beginning of any patient licensee relationship shall not be unprofessional conduct if treatment is conducted without third party compensation." (W.S. § 33-40-102(a)(vi)(B) (opens in a new tab)) That is the only rule I found that ties treating a family member to billing: in Wyoming the protection holds only if no third party pays.

Eight states carve the spouse out of the sex ban

These rules don't say you may treat your spouse. They say the sexual-misconduct ban doesn't apply when the patient is your spouse, which only makes sense if the law expects some clinicians to treat one.

  • California (all three). For every healing-arts licensee, the ban "shall not apply to consensual sexual contact between a licensee and his or her spouse or person in an equivalent domestic relationship when that licensee provides medical treatment, other than psychotherapeutic treatment, to his or her spouse or person in an equivalent domestic relationship." (Cal. Bus. & Prof. Code § 726(b) (opens in a new tab)) The OT board's ethics rule has its own version for a licensee who "provides occupational therapy services to his or her spouse, registered domestic partner, or person in an equivalent domestic relationship," and also tells OTs to "avoid relationships or associations that include, but are not limited to, emotional, physical, psychological, financial, and social, or activities that interfere with professional judgment and objectivity." (16 CCR § 4170(b)(2)-(3) (opens in a new tab))
  • Idaho (PT and SLP). The PT ban "shall not apply to sexual contact between a physical therapist or physical therapist assistant and the physical therapist’s or physical therapist assistant’s spouse or a person in a domestic relationship who is also a patient." (Idaho Code § 54-2219(10)(b) (opens in a new tab)) The speech and hearing act has the same exception for "such licensee’s spouse or a person in a domestic relationship with the licensee who is also a client." (Idaho Code § 54-2923(14)(b) (opens in a new tab))
  • Indiana (all three). "A practitioner who provides health care services to the practitioner's spouse is not subject to disciplinary action under subsection (a)(11)," which is the ground for sexual contact with "a patient under the practitioner's care." The chapter covers the PT board, the OT committee and the speech-language pathology board. (IC 25-1-9-4(b) (opens in a new tab))
  • North Dakota (PT). The ban covers sexual relationships "while a physical therapist or physical therapist assistant-patient relationship exists, except with a spouse." (N.D.C.C. § 43-26.1-13(11)(a) (opens in a new tab))
  • Ohio (PT and OT). Grounds for discipline include, "Regardless of whether it is consensual, engaging in any of the following with a patient other than the spouse of the physical therapist or physical therapist assistant." (R.C. 4755.47(A)(25) (opens in a new tab)) The OT section reads the same. (R.C. 4755.11(A)(25) (opens in a new tab))
  • Pennsylvania (PT). For the sexual-misconduct rules, a patient is "A person, other than the spouse of the physical therapist or physical therapist assistant, who receives professional services from the physical therapist or physical therapist assistant." (49 Pa. Code § 40.301 (opens in a new tab))
  • New Hampshire (SLP). Sexual misconduct is defined for "a current client who is not a spouse or civil union partner." (N.H. Admin. R. Spe 401.01(f) (opens in a new tab))
  • Arkansas (SLP). "Individuals shall not engage in sexual activities with individuals (other than a spouse or other individual with whom a prior consensual relationship exists) over whom they exercise professional authority or power, including persons receiving services." (ABESPA Rule § 8.4(M) (opens in a new tab))

The California and Indiana laws apply across their health professions, so they reach PTs, OTs and SLPs alike. The others are written for one profession.

New York's Guidance on Relatives

New York's PT board is the only one I found that names relatives as patients. Its practice alert on professional boundaries says: "While the following types of relationships may not be strictly prohibited, the close personal nature of the relationship may raise serious questions about whether the physical therapist is maintaining appropriate boundaries: accepting as a patient/client any one with whom you have had a prior sexual relationship; treating patients/clients to whom you are related by blood or legal ties." The alert also says that not following it "may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations." (NYSED, Maintaining Appropriate Professional Boundaries (opens in a new tab), board statement)

So it's a caution, not a ban. New York's OT and speech-language pathology pages have no matching guidance; the rule for all three is the Regents' unprofessional-conduct rule. (8 NYCRR § 29.1 (opens in a new tab))

Rules That Reach It Without Naming Family

Treating a relative puts you in two roles with one person. These rules don't mention family, but their words cover that kind of overlap.

  • Montana (all three). One rule covers PTs, OTs and SLPs, who share a board. Unprofessional conduct includes "maintaining a relationship with a client ... when such relationship ... is likely to impair the licensee’s professional judgment or result in client harm." (Admin. R. Mont. 24.119.2301(1)(e) (opens in a new tab))
  • Kentucky (SLP). The clearest of these. A licensee shall not "engage in a dual relationship with a patient, including a social, business, or personal relationship that may: a. Impair professional judgment; b. Incur a risk of exploitation of the patient." And: "If a dual relationship cannot be avoided, and does not impair professional judgment, incur a risk of exploitation of the patient, or otherwise violate a provision of this administrative regulation, a licensee shall take appropriate professional precautions to ensure that judgment is not impaired and exploitation of the patient does not occur." (201 KAR 17:041, § 1(2)(b) (opens in a new tab)) Kentucky's rule expects that some dual relationships can't be avoided, and tells you what to do then.
  • Ohio (SLP). "Dual relationship means when more than one role occurs between the licensee and person(s) being served professionally. A dual relationship is prohibited when the relationship between the licensee and person(s) being professionally served involves a sexual or intimate relationship or other conduct that constitutes a conflict of interest." A conflict of interest "means personal, financial, or other considerations influenced or compromised professional judgment and objectivity." (Ohio Adm.Code 4753-9-01 (opens in a new tab)) Ohio's OT rule asks licensees to disclose "any professional, personal, financial, business, research, or volunteer affiliations that may pose a conflict of interest." (Ohio Adm.Code 4755:1-2-01 (opens in a new tab))
  • Louisiana and Arkansas (SLP). Both copy the 2016 ASHA wording: "Individuals shall avoid engaging in conflicts of interest whereby personal, financial, or other considerations have the potential to influence or compromise professional judgment and objectivity." (La. Admin. Code tit. 46, pt. LXXV, § 701 (opens in a new tab); ABESPA Rule § 8.3(B) (opens in a new tab))
  • Illinois and Maryland (OT). Illinois: "Occupational therapy practitioners shall avoid those relationships or activities that interfere with professional judgment and objectivity." (68 Ill. Adm. Code 1315.165(b)(2) (opens in a new tab)) Maryland: "The licensee shall avoid a relationship or an activity with the client that interferes with professional judgment and objectivity." (COMAR 10.46.02.02A (opens in a new tab))
  • Texas and South Carolina (OT). Both print AOTA's 2015 code in their rules, including: "Avoid dual relationships, conflicts of interest, and situations in which a practitioner, educator, student, researcher, or employer is unable to maintain clear professional boundaries or objectivity." (40 TAC § 374.4 (opens in a new tab); S.C. Code Regs. 94-10 (opens in a new tab))
  • West Virginia (OT). OTs must "Maintain therapeutic relationships that do not exploit the recipient of services" and "Avoid relationships or activities" that conflict or interfere with professional judgment and objectivity. (W. Va. Code R. § 13-6-4.2 (opens in a new tab))

Two speech rules come at it from the other side. Among the things a licensee shall not do, Ohio's lists "Engage in the evaluation or remediation of speech, language, or hearing disorders except in a professional relationship" (Ohio Adm.Code 4753-9-01 (opens in a new tab)), and Oklahoma's says "Licensees must not provide clinical services except in a professional relationship" (OAC 690:15-1-4 (opens in a new tab)). Neither bans treating a relative. Both mean that if you do it, you do it as a clinician, with an evaluation, a plan and records, not as informal help at the kitchen table.

One near miss is worth knowing in home health. Nevada's OT conflict-of-interest rule is about working for a relative, not treating one: a licensee must avoid an actual or perceived conflict where the licensee "Is the spouse or the parent or child, by blood, marriage or adoption, of: (1) The owner or manager of a business at which the licensee provides occupational therapy services; or (2) The immediate supervisor of the licensee who is also a licensee," and must keep records of the steps taken to avoid it. (NAC 640A.225 (opens in a new tab))

What the National Codes Say

The three national codes bind their own members and certificants. They bind every licensee only where a state writes them into its rules, and the edition matters.

APTA (PTs and PTAs)

APTA's Code of Ethics for the Physical Therapy Profession (opens in a new tab), in effect since January 1, 2026, has no rule on treating family. Its enforceable standard on conflicts is short: "Physical therapists and physical therapist assistants shall disclose any conflicts of interest and not permit any conflicts of interest to interfere with professional judgments and decisions." (Standard 6.3)

The closest it comes is an aspirational example, not a standard: PTs and PTAs "should refer patients and clients to other providers if an existing close personal or sexual relationship with such a person might influence or impinge on the integrity of the relationship between the provider and patient or client." (4.A) Read in full, "such a person" means someone with "significant influence on patients’ and clients’ care decisions," such as a family member who makes decisions for the patient. So the example is about a close relationship with the patient's decision-maker, but the reasoning applies just as well to a close relationship with the patient.

Earlier editions, which many states still adopt, say "Physical therapists shall not engage in conflicts of interest that interfere with professional judgment" (Code of Ethics for the Physical Therapist, 3D (opens in a new tab)) and "Physical therapist assistants shall not engage in conflicts of interest that interfere with making sound decisions" (Standards of Ethical Conduct for the PTA, 3D (opens in a new tab)). Nineteen jurisdictions adopt APTA's code in some form; our article on dating a former patient lists them.

AOTA (OTs and OTAs)

The AOTA 2025 Occupational Therapy Code of Ethics (opens in a new tab) (published in the American Journal of Occupational Therapy, copy posted by the Oregon OT Licensing Board) has no rule on treating family either. Its standard on relationships says: "Do not initiate or continue dual relationships or situations (e.g., sexual, financial, substance use, etc.) that jeopardize professional objectivity or team effectiveness or that pull the focus from the promotion of service recipients’, students’, or research participants’ safety and well-being." (2E) Its conflict-of-interest standard is about work, not patients: "Do not engage in conflicts of interest or conflicts of commitment in employment, volunteer roles, or research." (1J)

The 2020 edition (opens in a new tab), which several states adopt by name, said: "Do not engage in dual relationships or situations in which an occupational therapy professional or student is unable to maintain clear professional boundaries or objectivity." (2I)

Fifteen jurisdictions adopt AOTA's code by reference: Arkansas, DC, Louisiana, Massachusetts and Nevada (the current edition), Illinois and Pennsylvania (2015), Maine, Tennessee and Utah (2020), New Hampshire (2015 as revised in 2020), North Carolina (2005 and later editions), North Dakota (2015), Oregon (2025) and Rhode Island (no edition given). South Dakota's board may use the 2010 code as guidance, Texas and South Carolina print the 2015 text in their own rules, and Georgia and Oklahoma wrote their own codes modeled on AOTA's.

ASHA (SLPs)

ASHA's Code of Ethics (opens in a new tab), effective March 1, 2023, says: "Individuals shall avoid engaging in conflicts of interest whereby a personal, professional, financial, or other interest or relationship could influence their objectivity, competence, or effectiveness in performing professional responsibilities. If such conflicts of interest cannot be avoided, proper disclosure and management is required." (Principle III)

ASHA's ethics guidance goes further than any state rule. Its Issues in Ethics statement on conflicts of professional interest (opens in a new tab) says: "Similarly, recusal may be warranted if a professional is asked to provide services to a family member or a close friend." It also says: "Involvement in the professional assessment (clinical, academic, or administrative) of someone who is a friend can constitute a conflict of interest." That statement is guidance, not part of the code.

Seven jurisdictions adopt ASHA's code for SLPs: DC and Massachusetts (the current edition), Illinois and Rhode Island (2016), Utah (2010), North Carolina (the edition in effect on January 1, 2013), and Vermont, whose statute makes "violating any part of the Code of Ethics of the American Speech-Language-Hearing Association" unprofessional conduct (26 V.S.A. § 4464(b)(16) (opens in a new tab)).

Alabama, Georgia, Maine, New Mexico and South Carolina use an older, shorter form in their own speech rules that bars activities that "constitute a conflict of interest" without mentioning personal relationships (Ala. Admin. Code r. 870-X-6-.04 (opens in a new tab)).

Medicare and Other Payers

This part is federal payment law, not your practice act. A state can let you treat your mother and Medicare can still refuse to pay for it.

The rule is 42 CFR 411.12 (opens in a new tab). Its basic rule: "Medicare does not pay for services usually covered under Medicare if the charges for those services are imposed by— (1) An immediate relative of the beneficiary; or (2) A member of the beneficiary's household." It defines both:

Immediate relative means any of the following: (1) Husband or wife. (2) Natural or adoptive parent, child, or sibling. (3) Stepparent, stepchild, stepbrother, or stepsister. (4) Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law. (5) Grandparent or grandchild. (6) Spouse of grandparent or grandchild.

Member of the household means any person sharing a common abode as part of a single family unit, including domestic employees and others who live together as part of a family unit, but not including a mere roomer or boarder.

The key words are "charges ... imposed by." For services other than a physician's, the rule reaches "Charges imposed by an individually owned provider or supplier if the owner has an excluded relationship to the beneficiary" and "Charges imposed by a partnership if any of the partners has an excluded relationship to the beneficiary." And: "The exclusion does not apply to charges imposed by a corporation other than a professional corporation." (42 CFR 411.12(c)(2), (d) (opens in a new tab))

CMS's Medicare Benefit Policy Manual, chapter 16, § 130 (opens in a new tab) explains why: "The intent of this exclusion is to bar Medicare payment for items and services that would ordinarily be furnished gratuitously because of the relationship of the beneficiary to the person imposing the charge." For providers such as home health agencies: "Payment is not made under Part A or Part B for items and services furnished by providers to immediate relatives of the owner(s) of the providers. This exclusion applies whether the provider is a sole proprietor who has an excluded relationship to the patient, or a partnership in which even one of the partners is related to the patient." The manual adds that step and in-law relationships continue "even if the marriage upon which the relationship is based is terminated through divorce or through the death of one of the parties."

Here is how I read that, as a clinician and not a billing expert:

  • You work for a home health agency. The exclusion looks at the agency's owners. If the agency is a sole proprietorship or partnership and an owner or partner is related to the patient, Medicare won't pay. If the agency is an ordinary corporation, this rule doesn't block payment just because the visiting therapist is the patient's relative. Your agency may still have its own policy against it, and many do.
  • You're in private practice and bill Medicare yourself. As a sole proprietor or partnership, you can't be paid for treating your spouse, parent, child, sibling, in-laws or grandparents, or anyone in your household. If your practice is incorporated, the type of corporation matters; ask whoever handles your billing.
  • Friends aren't covered. The exclusion is about relatives and household members only.

Commercial insurers and Medicare Advantage plans often have their own exclusions for care from a family member. Check the plan's terms before you assume it will pay.

If You're Thinking About Treating Someone Close to You

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

  1. Read your own state's row, for your profession. In Wyoming, an OT who treats a spouse is protected only if no third party pays.
  2. Ask your employer first. In home health, the agency decides who gets assigned, and many agencies won't send a clinician to a relative's home. Ask the scheduler to assign someone else if you can.
  3. Check who pays. If the patient is on Medicare and you or your practice would be the one billing, look at the immediate-relative rule above before the first visit.
  4. Be honest about objectivity. Could you tell your mother she isn't making progress, or discharge your friend when the goals are met? If not, the dual-relationship rules above are exactly about you.
  5. If you go ahead, do it as a clinician. Evaluate, write the plan, document every visit and get the orders you'd get for anyone else. Ohio's and Oklahoma's speech rules say services belong in a professional relationship.
  6. Tell the patient they can choose someone else, and refer them if the relationship starts to get in the way.
  7. When in doubt, ask your board. It can tell you how it reads its own rule. Our licensure compact tool links each state's PT, OT and speech board.

Key Takeaways

  • No state's PT, OT or SLP practice act or board rules bans treating family or friends, and no state names parents, children, siblings or friends.
  • Eleven states write in a spouse or partner, mostly as a carve-out from the sexual-misconduct ban. New Jersey, Washington and Wyoming go further, and Wyoming's OT act allows it only without third-party payment.
  • New York's PT board is the only one that names relatives, in guidance that isn't binding.
  • Dual-relationship and conflict-of-interest rules still apply, in the states' own words or through the AOTA, ASHA and APTA codes they adopt.
  • Medicare won't pay charges imposed by an immediate relative or household member, and for a home health agency it depends on who owns the agency.
  • 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, OT or SLP treat a family member?

In every state I checked, nothing in the PT, OT or speech-language pathology practice act or board rules forbids it. No state names a parent, child, sibling or friend as someone you may not treat. Eleven states mention a spouse or partner, mostly to exempt them from the sexual-misconduct ban, which assumes you may be treating them. The general rules still apply: dual-relationship and conflict-of-interest rules, the AOTA and ASHA codes many states adopt, and your duty to stay objective.

Will Medicare pay if I treat my own parent in home health?

It depends on who bills. Medicare does not pay charges imposed by an immediate relative or a member of the patient's household. For a home health agency, the federal rule looks at the agency's owners: it applies when the agency is a sole proprietorship or partnership and an owner or partner is related to the patient. It does not apply to charges imposed by a corporation other than a professional corporation. A therapist in private practice who bills Medicare as a sole proprietor or partnership can't be paid for treating an immediate relative. Ask your agency's billing or compliance staff before you schedule yourself.

Which states say you may treat your spouse?

New Jersey's PT and OT rules say nothing in the sexual-misconduct rule prevents you from treating a spouse, if the care meets accepted standards. Washington's PT, OT and SLP rules do not prohibit care for someone you are in a pre-existing, established relationship with, if there is no exploitation. Wyoming's OT act says treating a spouse or significant other is not unprofessional conduct if the relationship came first and the treatment is given without third-party compensation.

What do the APTA, AOTA and ASHA codes say about treating family?

None of the three codes bans it. APTA's code requires you to disclose conflicts of interest and not let them interfere with your judgment. AOTA's 2025 code says not to start or continue dual relationships that jeopardize professional objectivity. ASHA's code says to avoid conflicts of interest where a personal relationship could influence your objectivity, and ASHA's ethics guidance says recusal may be warranted when you are asked to treat a family member or a close friend.

Can I treat a friend?

No state rule I found names friends. The same general rules apply as for relatives: avoid a dual relationship that could cloud your judgment, keep the same records and standards you would for anyone else, and hand the case off if you can't stay objective. ASHA's ethics guidance says assessing someone who is a friend can be a conflict of interest.

Sources

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

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