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I agree with Dr Draper's assessment of the certified athletic trainer's education and ability to use therapeutic modalities safely and effectively (Draper DO. Are certified athletic trainers qualified to use therapeutic modalities? J Athl Train. 2002;37:11–12).
Having the training, certification, and, in many cases, the license to provide therapeutic modalities does not always equate with being able to provide this treatment in all practice situations.
Practice acts for physicians, licensed athletic trainers, and physical therapists are put in place by each state to protect its citizens, and they vary immensely from state to state.
Some practice acts allow a professional to have another professional deliver care under supervision (ie, a physician can have a certified licensed athletic trainer deliver therapeutic modalities in his or her facility, call it medical care, and charge for it even though the physician did not deliver the service).
Some practice acts allow only the professional to deliver the care and do not allow anyone else, no matter how qualified, to deliver that care (ie, a physical therapist must perform the therapeutic modality if he or she is providing physical therapy services).
Then there are practice acts that provide for every situation in between. Some physical therapy practice acts allow therapists to use anyone they deem appropriate to deliver the care as long as the therapist provides line-of-sight supervision. Even though these therapists are not breaking their state law to have a certified or licensed athletic trainer deliver the service under line-of-sight supervision, they may be violating federal standards or standards set forth by third-party payers.
Medicare requires that when physical therapy services are being delivered, only a physical therapist or physical therapist's assistant may perform the service or the fees will not be reimbursed. Medicare facilities, such as most hospitals and Medicare-recognized outpatient physical therapy clinics, must follow Medicare guidelines in the delivery of care in their institution.
Most current procedural terminology (CPT) codes can be used by any appropriate professional in the delivery of care he or she is licensed to provide; however, by definition, CPT codes are to be used by the professional delivering the care. In other words, if athletic training services are being delivered, a certified licensed athletic trainer should perform the service. If physical therapy services are being delivered, a physical therapist should deliver the care. So even using CPT codes—the backbone of reimbursement—puts demands on the provider to have the appropriately licensed individual deliver the care.
Maybe this is all semantics, but certified, licensed athletic trainers should deliver athletic training services as defined by their practice act. These services should not be performed for another profession. But also remember, the practice act is not the sole determination of reimbursement.
The precedent is already set. Physical therapists and occupational therapists work as a team to care for their patients, and their practice acts overlap. Both can perform therapeutic modalities and both can perform activities of daily living. However, they each have different scopes of service that provide unique services that meet patient needs.
Why should physical therapists have certified licensed athletic trainers perform ultrasound or any other service for them? Athletic training has a scope of practice that includes activities other professionals do not have. Let's develop that market delineation within our own practice act rather than trying to work within another profession's practice act where we are recognized as aides.