PTA Supervision by State: What to Know Across U.S. Jurisdictions

Supervision requirements for physical therapist assistants vary widely across the United States. Understanding these differences is critical for ensuring compliance, maintaining care quality, and structuring effective staffing models—especially for organizations operating in multiple states.

In this article, we’ll review how supervision is defined in PT/PTA practice, outline key differences in state ratios, and highlight practical considerations to help clinics stay compliant across jurisdictions.

Foundations of supervision

Before reviewing state ratios, it’s helpful to define what supervision means in physical therapy practice, particularly between the physical therapist (PT) and physical therapist assistant (PTA).

The supervising PT retains responsibility for all aspects of patient evaluation, plan development, reassessment, and any care delegated to a PTA. While PTAs implement components of the treatment plan, they cannot independently modify goals or interventions.

Supervision is typically categorized as:

• General: The PT is available remotely (e.g., by phone or telecommunication).

• Direct or on-site: The PT is physically present or immediately accessible.

• Continuous or in-room: The PT remains present throughout treatment.

Requirements can differ by setting (acute care, outpatient, home health, or school-based) and patient complexity. Some states also count students, aides, or unlicensed personnel toward the total number of supervised individuals, which can affect how ratios are applied.

Supervision ratios across states

Each state defines PTA supervision differently. Many establish specific numeric ratios, while others rely on professional judgment.

• Fixed-ratio states (e.g., California, Minnesota, Colorado) set clear limits on how many PTAs or assistive personnel a PT can supervise at one time.

• Flexible states (e.g., Florida, Massachusetts, Texas) allow PTs to determine appropriate supervision levels based on patient needs and clinical judgment.

Even among fixed-ratio states, inclusion rules vary. Some count aides, students, or other assistive personnel within the cap, while others apply ratios exclusively to PTAs. As a result, a ratio of “three supervisees” in one state might not equate to the same oversight structure in another.

Operational impact

Understanding PTA supervision requirements is essential for effective staffing, compliance, and quality assurance. These rules don’t just affect ratios on paper—they directly shape how care is delivered, how teams are structured, and how efficiently clinics can operate across settings.

• Planning: States with lower supervision caps may require additional PTs to manage caseloads, while flexible models allow broader delegation.

• Accountability: In states without fixed ratios, PTs should document how supervision decisions are made and supported.

• Multi-state operations: Organizations practicing across jurisdictions must tailor staffing models to meet each state’s regulations and maintain consistent oversight.

Example application

To see how supervision rules can affect day-to-day operations, consider a clinic network with locations in Colorado, Minnesota, and Texas:

• Colorado allows up to four supervisees, including PTAs, aides, and students.

• Minnesota limits supervision to two PTAs per PT.

• Texas uses professional judgment instead of a numeric ratio.

In this case, staffing and scheduling need to balance flexibility with compliance. A best practice is to adopt the most restrictive supervision rule across all locations—this simplifies training, ensures regulatory alignment, and reduces the risk of accidental overages.

In addition, clinics should maintain written supervision policies, train PTs on ratio limits and documentation standards, and perform periodic internal audits to confirm adherence. This approach supports compliance while building a scalable, transparent model of high-quality care.

State-by-state PTA supervision requirements

The following overview summarizes PTA supervision across U.S. jurisdictions, including ratio limits, categories of personnel included, and operational considerations.

Because supervision laws vary so widely, understanding the specific rules in each state is key to maintaining compliance. Use the summary below as a starting point when reviewing your jurisdiction’s current regulations.

Alabama

Alabama allows a PT to supervise up to four individuals at once, including PTAs, aides, and students. Clinics should track the combined headcount throughout the day so staffing shifts don’t accidentally exceed the cap.¹

Alaska

Alaska caps supervision at three. PTs should account for aides, students, and any temporary licensees included in the state’s categories to stay within the limit during busy sessions.¹

Arizona

Arizona limits supervision to three individuals. Although the state issues interim permits rather than temporary licenses, teams should still include these personnel within overall supervision counts.¹

Arkansas

Arkansas lists no fixed supervision ratio. PTs rely on professional judgment and standards of care, which provides flexibility but increases the need for clear internal policies and documentation of oversight decisions.¹

California

California allows no more than two PTAs and one aide per supervising PT at the same time. Because aides are explicitly included, schedules should allocate both PTA and aide slots to maintain compliance across overlapping appointments.^1-3

Colorado

Colorado permits up to four supervisees per PT, including aides and students. Leaders should monitor total group size rather than PTA-only counts.¹

Connecticut

Connecticut lists no fixed ratio. PTs should adjust supervision to case complexity, setting, and staffing, while maintaining documentation that support their decisions.¹

Delaware

Delaware limits each PT to two supervisees. The narrow cap supports close oversight and frequent PT involvement in daily operations.¹

Florida

Florida has no numeric cap, allowing PTs to determine supervision levels based on patient needs and setting. Organizations should document the rationale for their chosen supervision structures.^1,4

Georgia

Georgia caps supervision at two. This limit can affect scheduling, especially when clinics employ aides or student learners who may be counted under certain conditions.¹

Hawaii

Hawaii allows up to three supervisees. Managers should plan schedules with buffer time to avoid exceeding limits during shift changes.¹

Idaho

Idaho ties supervision to staffing ratios—two PTAs per three PTs. Because the standard is proportional, staffing changes can affect PTA capacity, requiring coordination between HR and clinical leads.¹

Illinois

Illinois lists no supervision ratio. PTs should align oversight intensity to patient risk and care setting, conducting regular internal audits for compliance.¹

Indiana

Indiana allows up to three PTAs. Daily PT/PTA consultations are required and may limit the number of PTAs supervised if interactions are not face-to-face. Organizations should build check-ins into workflows to keep counts compliant.¹

Iowa

Iowa caps supervision at the equivalent of two full-time PTAs, with additional limits on part-time combinations within a single day. Teams using split shifts should reconcile full-time equivalent totals daily to ensure compliance.¹

Kansas

Kansas permits up to four supervisees, including aides and students. Schedules should reflect total headcount, not PTA-only numbers.¹

Kentucky

Kentucky sets the cap at four. It’s moderately flexible, yet still requires documentation of how the supervising PT maintains oversight across assigned personnel.¹

Louisiana

Louisiana allows up to five supervisees, with sub-limits by category (PTAs, technicians, provisional licensees, students). Compliance depends on tracking both category counts and total numbers.¹

Maine

Maine lists no supervision ratio. Supervising PTs should calibrate the number of personnel to patient complexity and setting, and keep evidence of oversight in records and policies.¹

Maryland

Maryland lists no numeric ratio. The absence of a fixed cap places emphasis on the supervising PT’s judgment and contemporaneous documentation.¹

Massachusetts

Massachusetts uses professional judgment rather than a fixed number. Clear internal protocols—case huddles, review intervals, escalation procedures—help defend supervision decisions if questioned.¹

Michigan

Michigan allows up to four supervisees. Given the cap, coverage plans should be in place for sudden PT absences so the total supervised headcount doesn’t exceed the limit.¹

Minnesota

Minnesota restricts supervision to no more than two PTAs per PT. Multi-state organizations often standardize to Minnesota’s cap to simplify staffing models and reduce compliance risk.^1,5

Mississippi

Mississippi caps at four. Clinics should watch split roles (e.g., aide-plus-student) so the sum of supervised personnel stays under the threshold throughout the day.¹

Missouri

Missouri sets a cap of four supervisees per PT. This supports some delegation while preserving oversight: case review checkpoints help demonstrate active PT involvement.¹

Montana

Montana limits supervision to two. It’s among the stricter standards, so daily productivity targets may need tighter alignment with PT availability.¹

Nebraska

Nebraska sets a cap of two supervisees. Short rosters or staggered patient arrivals can prevent unintentional overages during overlap windows.¹

Nevada

Nevada permits up to three supervisees, with a secondary rule that no more than two can be of the same personnel type at once. Mix composition matters here, and PTs must mind both total and per-type limits.¹

New Hampshire

New Hampshire lists no ratio. Supervising PTs should plan oversight intensity to setting and risk, and keep written protocols on when in-person vs. remote contact is used.¹

New Jersey

New Jersey caps a supervising PT at two personnel. The small number favors closer PT participation in care delivery and frequent check-ins.¹

New Mexico

New Mexico sets the limit at three. The rule references full-time equivalent totals across personnel categories, so administrators should track combined weekly hours, not just headcount.¹

New York

New York lists no supervision ratio in the Federation of State Boards of Physical Therapy (FSBPT) jurisdictional guide. PTs should use internal thresholds tied to patient complexity and setting to guide delegation and oversight intensity.¹

North Carolina

North Carolina caps supervision at four, and notes related limits for trainees and those on limited permits. Day-of scheduling should account for those additional constraints.¹

North Dakota

North Dakota permits up to three supervisees but limits PTAs to no more than two within that total. Count both the overall and PTA-specific limits when building templates.¹

Ohio

Ohio lists no numeric ratio. PTs should formalize review cadence (e.g., same-day or next-day chart reviews) to evidence active oversight.¹

Oklahoma

Oklahoma lists no ratio. Teams should rely on written criteria for assigning cases to PTAs and aides, with escalation steps for more complex patients.¹

Oregon

Oregon caps at two supervisees. It’s a narrower standard that benefits from tight PT/PTA communication loops and predictable reassessment intervals.¹

Pennsylvania

Pennsylvania allows up to three supervisees. Audit-friendly documentation—who the supervising PT is for each PTA and how contact is maintained—helps demonstrate compliance.¹

Rhode Island

Rhode Island lists no ratio. Because the ceiling is undefined, more attention should go to documenting the PT’s decision-making around oversight, especially in higher-risk settings.¹

South Carolina

South Carolina caps supervision at three. Clarify internally how aides and other assistive personnel are counted so the total doesn’t drift above the ceiling during handoffs.¹

South Dakota

South Dakota limits a supervising PT to two. Consider staggered start times and tighter visit batching to avoid accidental overages during shift overlaps.¹

Tennessee

Tennessee sets a cap of three PTAs and also limits assistive personnel to the equivalent of two full-time. Because multiple ceilings apply, clinics need to monitor both headcount and full-time equivalent totals to remain compliant.¹

Texas

Texas uses professional judgment rather than a numeric cap. PTs tailor supervision to case mix and setting; organizations should standardize contact frequency, escalation triggers, and documentation to support oversight decisions.^1,6

Utah

Utah allows up to three supervisees. If teams rely on students or aides for throughput, templates should reserve supervision “slots” so PTAs aren’t squeezed out late in the day.¹

Vermont

Vermont lists three as the supervision cap for mixed groups, though PTs may supervise up to four PTAs when not combining with other categories. Because rules differ by mix, pay attention to composition, not just totals.¹

Virginia

Virginia allows up to three supervisees. For multi-site providers, use Virginia’s mid-range cap as a baseline and adjust downward only where other states are stricter.¹

Washington

Washington allows up to three assistive personnel at one time, but only one may be a PT aide when at the 3-person maximum. Settings such as nursing homes and public schools have additional limits, so clinic leaders should segment policies by site type.¹

West Virginia

West Virginia permits up to four supervisees. PTs should build monitoring into daily operations so substitute coverage doesn’t break the cap during unexpected absences.¹

Wisconsin

Wisconsin lists four as the total cap and clarifies that no more than two of the supervised personnel may be PTAs. Count the overall limit and the PTA-specific cap when planning daily assignments.¹

Wyoming

Wyoming allows up to five supervisees, making it one of the more flexible states; however, no more than three may be aides, and a PTA may supervise no more than two aides. Track category-level limits to stay safely within the rules.¹

Staying compliant across states

PTA supervision requirements can significantly influence how care teams are structured and managed. Staying informed about evolving state regulations—and implementing clear, well-documented policies—helps ensure consistent compliance and high-quality care. Regularly reviewing updates from your state board and the FSBPT is the best way to keep your organization aligned with current standards.

Disclaimer: The information in this article, including supervision ratios and state-specific requirements, is provided for general educational purposes only and does not constitute legal or regulatory advice. Supervision rules may change over time, and interpretations can vary by jurisdiction. Readers are responsible for consulting the official state practice acts, administrative codes, and licensing boards for the most current and applicable regulations. Medbridge and the author assume no liability for decisions made based on the information provided here.

References

1. Federation of State Boards of Physical Therapy (FSBPT). Jurisdiction Licensure Reference Guide — PT Supervision Ratios (accessed Oct 1, 2025). https://www.fsbpt.org/LRG/Home/SupervisionRatio

2. California Business and Professions Code, Div. 2, Ch. 5.7, Sec. 2622(b–c). https://law.justia.com/codes/california/code-bpc/division-2/chapter-5-7/article-2/section-2622/

3. Physical Therapy Board of California. Law Reference Guide. https://www.ptbc.ca.gov/publications/law_reference_guide.pdf

4. Florida Administrative Code 64B17-6.007(8) supervision language summarized by FSBPT. https://floridasphysicaltherapy.gov/forms/pt-study.pdf

5. Minnesota Statutes § 148.706. https://www.revisor.mn.gov/statutes/cite/148.706

6. Texas Administrative Code, Title 22, Part 16, Chapter 322, Rule § 322.3(a). https://www.law.cornell.edu/regulations/texas/22-Tex-Admin-Code-SS-322-3