A small but growing number of U.S. states explicitly grant physical therapists the authority to order diagnostic imaging, though the specific type of imaging allowed and the qualifications required vary significantly. Wisconsin, West Virginia, and North Dakota have adopted statutory language permitting qualified physical therapists to order radiographs (X-rays). Physical therapists in the U.S. military health system have broader imaging privileges nationwide, and some hospital systems in states like Pennsylvania and Washington D.C. have built institutional frameworks that allow their physical therapists to sign imaging referrals.
States With Explicit Imaging Laws
Wisconsin has the most detailed legislation on the books. Under state statute 448.56(7), a physical therapist can order X-rays if they meet at least one of four qualifications: holding a clinical doctorate in physical therapy (DPT), completing a nationally recognized specialty certification program, completing a recognized residency or fellowship, or finishing a formal X-ray ordering training program with demonstrated physician involvement. The law limits this authority to plain radiographs, not advanced imaging like MRI or CT scans. It also requires the physical therapist to coordinate with the patient’s primary care physician or referring provider after ordering the X-ray, unless a radiologist reads the film with no significant findings and the patient has no referring provider or primary care doctor on file.
North Dakota recently adopted language allowing physical therapists who hold a clinical doctorate in physical therapy to order radiographs. West Virginia’s Board of Physical Therapy has similarly provided a list of recommended practitioner qualifications, including graduation from an accredited DPT program, for those ordering imaging. Both states follow the same general pattern as Wisconsin: the authority covers X-rays, requires specific credentials, and is narrower than what a physician can order.
Institutional Authority in Other States
Even in states without specific imaging statutes, some health systems have created their own pathways for physical therapists to sign imaging referrals. At MedStar Georgetown University Hospital in Washington D.C., physical therapists who complete internal competency requirements have organizational authority to sign referrals for any diagnostic imaging study they deem appropriate. This includes advanced imaging like MRI and CT, not just X-rays.
At St. Luke’s University Health Network in Pennsylvania, physical therapists functioning as direct-access providers (seeing patients without a physician referral) ordered both basic and advanced imaging. In a multi-center study of 596 imaging referrals signed by physical therapists across three institutions, 71% of the imaging orders at the Pennsylvania site were for advanced studies like CT, MRI, or bone density scans. These institutional models work within the broader legal framework of each state, often leveraging direct-access laws and collaborative agreements rather than relying on a specific imaging statute.
Military and VA Health Systems
Physical therapists in the U.S. military operate under one of the widest scopes of practice in the country. They serve as direct-access providers and can order X-rays, MRIs, and CT scans. They also make direct specialty referrals and, in some settings, prescribe certain medications. This model has been in place for decades and is often cited as evidence that physical therapists can safely and effectively manage imaging decisions.
In published case studies from military settings, physical therapists used their imaging privileges to identify conditions that required surgical referral, contributing to faster diagnosis and treatment. A service member with a persistent ankle injury, for example, was imaged and referred to a surgeon by her physical therapist after conservative treatment stalled. The military model demonstrates that when physical therapists have imaging authority, patients can move through the system without needing a separate physician visit just to get a scan ordered.
What You Can and Cannot Order
The distinction between X-rays and advanced imaging matters. Most state laws that address physical therapist imaging authority limit it to plain radiographs. Wisconsin’s statute is explicit about this: X-rays are permitted, but MRI, CT, and bone density scans are not covered under state law. Advanced imaging in states like Pennsylvania happens through institutional credentialing, not state statute.
Point-of-care ultrasound is a separate category. Physical therapists in many states use handheld ultrasound in their clinics to guide treatment decisions, checking things like tendon integrity or muscle activation in real time. This is considered part of the physical therapy examination rather than a diagnostic imaging order. It is performed to direct a physical therapy intervention, not to provide a medical diagnosis. The legal and clinical distinction between using ultrasound at the bedside and ordering a formal diagnostic ultrasound from a radiology department is important, and the two should not be confused.
Insurance Coverage for PT-Ordered Imaging
One of the most common concerns about physical therapist-ordered imaging is whether insurance will actually pay for it. The evidence so far is reassuring. In a study analyzing 596 imaging referrals signed by physical therapists across three institutions in three different states, there were zero insurance claim denials. Every referral was processed by imaging centers in the same manner as referrals from any other provider.
That said, insurance plans sometimes require specific pre-approval steps for advanced imaging regardless of who orders it. A plan might require a specialist consultation before approving an MRI, for instance. These requirements apply to all providers, not uniquely to physical therapists. When physical therapists followed standard pre-approval processes, no patients were left responsible for covering the cost of an imaging study due to a denied claim.
Medicare has a narrower position. The Centers for Medicare and Medicaid Services currently recognizes physical therapists who are board-certified in clinical electrophysiology to furnish certain nerve and muscle diagnostic tests, but this recognition covers electromyography and nerve conduction studies, not X-rays or MRIs. Medicare reimbursement for those specific diagnostic services requires that the physical therapist holds the board certification and that state law permits the service.
Education Requirements and Qualifications
States that allow imaging authority consistently tie it to advanced credentials. The DPT (Doctor of Physical Therapy) is the entry-level degree for physical therapists graduating today, and it serves as the baseline qualification in most of these laws. Wisconsin, North Dakota, and West Virginia all reference the clinical doctorate as a qualifying credential.
Beyond the degree itself, some pathways require additional training. Wisconsin’s law includes completion of a formal X-ray ordering program with physician involvement as one of its four qualifying routes. Board-certified clinical specialists and residency or fellowship graduates also qualify. These requirements reflect the reality that while DPT programs include coursework on diagnostic imaging, the depth of that training varies across programs. States are essentially requiring either advanced education, specialty certification, or dedicated imaging training before granting ordering authority.
For physical therapists interested in practicing in a state without explicit imaging authority, institutional credentialing offers an alternative path. Health systems that have implemented imaging privileges for their physical therapists typically require completion of internal competency assessments before granting those privileges, similar to how hospitals credential physicians for specific procedures.