Telehealth in Physical Therapy: How It Works and Where It's Going

Telehealth transformed physical therapy practice during the pandemic, and the changes are sticking. Approximately 35 to 40% of PT practices now use telehealth in some form, and research increasingly shows that virtual PT produces outcomes comparable to in-person care for many conditions. Here is what telehealth PT looks like today, how it is regulated, and where it is headed.

How Telehealth PT Works

Telehealth physical therapy (also called telerehabilitation) uses video, audio, and digital tools to deliver PT services remotely. APTA defines it as the use of telehealth technologies by physical therapists to provide patient management, including evaluation, diagnosis, prognosis, and intervention.

Synchronous sessions are live video calls where the PT guides the patient through evaluation, exercise instruction, movement analysis, and education in real time. The patient demonstrates movements on camera while the PT provides cues, corrections, and progressions.

Asynchronous components include home exercise programs delivered through apps, remote therapeutic monitoring of patient adherence and outcomes, and secure messaging for check-ins between sessions.

Hybrid models combine telehealth sessions with periodic in-person visits for hands-on assessments and manual therapy that cannot be replicated virtually. This approach is gaining traction as it balances access and convenience with the hands-on care that defines physical therapy.

What It Is Good For

Telehealth PT works well for:

• Home exercise program instruction and progression
• Post-surgical follow-up and monitoring
• Chronic pain management and self-management education
• Movement screening and functional assessment
• Patient education on body mechanics, ergonomics, and injury prevention
• Vestibular rehabilitation exercises
• Balance and fall prevention programs

A 2025 systematic review in the Journal of Orthopaedic and Sports Physical Therapy found that self-managed rehabilitation applications and videoconferencing rehabilitation were the most effective telerehabilitation delivery modes for chronic musculoskeletal pain. A PMC review found that virtual PT demonstrates fair to excellent reliability and validity across key assessment areas, with outcomes similar to conventional treatment for pain, function, and quality of life.

Where It Has Limitations

Telehealth PT is not a substitute for all in-person care:

• Manual therapy (joint mobilization, soft tissue work) cannot be performed remotely
• Acute injuries requiring hands-on assessment (fractures, acute post-surgical) need in-person evaluation
• Complex neurological conditions may require direct observation and physical assistance
• Patients without technology access or reliable internet face barriers
• Some payers still do not reimburse telehealth PT at the same rate as in-person care

Medicare Coverage: Extended Through 2027

The regulatory landscape for telehealth PT has been turbulent. Medicare telehealth flexibilities for PTs were originally emergency provisions during COVID-19, and their continuation has required repeated congressional action.

After a 43-day government shutdown in late 2025 temporarily lapsed telehealth coverage, Congress passed the Consolidated Appropriations Act in February 2026, extending Medicare telehealth flexibilities for PTs through December 31, 2027.

Current Medicare telehealth rules (through Dec 31, 2027):

• Patients can receive telehealth PT services from their home (no facility requirement)
• No geographic restrictions on originating site
• Audio-only communication is permitted
• FQHCs and RHCs can serve as distant site providers

This is still a temporary extension. APTA continues to advocate for permanent legislation, including the CONNECT for Health Act and the Telehealth Modernization Act (H.R. 5081).

Remote Therapeutic Monitoring (RTM): PTs can now bill Medicare using CPT codes like 98980 for monitoring patient progress between visits, such as tracking home exercise adherence or collecting symptom feedback.

State Laws and Private Payer Reimbursement

State regulation of telehealth PT varies widely. As of the CCHP Fall 2025 report:

• 44 states + DC + Puerto Rico + USVI have laws addressing private payer telehealth reimbursement
• 24 states + Puerto Rico require payment parity (insurers must reimburse telehealth at the same rate as in-person care)
• 5 additional states have parity with caveats
• 22 states have no payment parity requirement

Notable recent developments: Texas now requires health plans to cover out-of-state telehealth services on the same basis as in-state (effective January 2026). Mississippi and Maryland made their private payer telehealth laws permanent. Montana prohibited insurers from applying higher copays or deductibles to telehealth services.

In many states, the physical therapy practice act is silent on telehealth. PTs should contact their state licensure board to confirm there are no limitations.

What This Means for DPT Students

Telehealth competency is increasingly expected of new graduates:

• Clinical education may include telehealth rotations or hybrid care experiences
• Interview preparation should include familiarity with telehealth trends (this is a common "current issues in PT" question)
• Technology literacy (video platforms, RTM tools, exercise prescription apps) is a practical skill
• The PT Compact makes telehealth across state lines easier by allowing practice in 37+ member jurisdictions without separate licenses

APTA has published clinical practice guidelines for telerehabilitation with 7 recommendations covering implementation, preparation, and impact assessment.

The Future

Telehealth PT is not going away. The question is whether current temporary extensions become permanent policy. The profession is moving toward:

• Permanent Medicare telehealth coverage for PTs (legislation pending)
• Expanded RTM reimbursement for between-visit monitoring
• AI-assisted movement analysis for more precise remote assessment
• Wearable sensor integration for real-time data collection during home exercises
• Virtual reality applications for neurological rehabilitation and pain management

For new graduates, telehealth fluency is no longer optional. It is a core practice competency alongside hands-on clinical skills.

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For more on the profession's direction, see direct access in physical therapy and the PT job market for new grads. For multi-state practice, see our upcoming post on the PT Compact.