1. On November 1, 2022, The Board of Physical Therapy issued Guidance Document:112-14 - “Guidance on Electromyography (“EMG”), Sharp Debridement, and Removal of Sutures, Staples, or Surgical Drains and the Practice of Physical Therapy,” that holds in relevant part:

Electromyography (“EMG”) EMG is an invasive procedure and requires referral and direction from a licensed practitioner, in accordance with Virginia Code § 54.1-3482.

Sharp Debridement Sharp debridement is an invasive procedure and requires referral and direction from a licensed practitioner, in accordance with Virginia Code § 54.1-3482.

Sutures, Staples, or Surgical Drains The removal of sutures or staples is an invasive procedure and requires referral and direction from a licensed practitioner, in accordance with Virginia Code § 54.1-3482.

2. On March 21, 2023, the Governor of Virginia approved unlimited direct access, to include dry needling, removing the requirement for physical therapists to obtain a prescription. Therefore, dry needling is no longer considered an “invasive procedure” within the practice of Physical Therapy

3. Va. Code §54.1-3482. Practice of physical therapy; certain experience and referrals required; physical therapist assistants states in relevant part:

D. Invasive procedures within the scope of practice of physical therapy shall at all times be performed only under the referral and direction of a licensed Doctor of Medicine, osteopathy, chiropractic, podiatry, or dental surgery, a licensed nurse practitioner practicing in accordance with the provisions of § 54.1-2957, or a licensed physician assistant acting under the supervision of a licensed physician.

4. 18 VAC l 12-20-170(B)(3) Confidentiality and practitioner-patient communication provides in relevant part: B. Communication with patients

3. Before any invasive procedure is performed, informed consent shall be obtained from the patient and documented in accordance with the policies of the health care entity. Practitioners shall inform patients of the risks, benefits, and alternatives of the recommended invasive procedure that a reasonably prudent practitioner in similar practice in Virginia would tell a patient. In the instance of a minor or a patient who is incapable of making an informed decision on his own behalf or is incapable of communicating such a decision due to a physical or mental disorder, the legally authorized person available to give consent shall be informed and the consent documented.

5. As of the date if this filing, the Virginia Board of Physical Therapy has promulgated no amendments to the administrative code to define “invasive procedure” other than its November 2022 Guidance Document 112-14, supra. See for example: Virginia Emergency Medical Services Regulations' definition of an "invasive procedure" is at 12VAC5-31-10 and the Virginia Board of Medicine's definition of “invasive procedure” is at 18VAC85-140-150(A)(3)(c).

6. Is Pelvic Floor Therapy an invasive procedure in the practice of Physical Therapy? The APTA and the VPTA's pelvic health documentation gives guidance on how the Commonwealth of Virginia’s Administrative Process Act should be outlined, including but not limited to, is pelvic floor therapy within the scope of practice for physical therapy, and if a student PT or PTA can perform pelvic floor therapy without pelvic floor certification or without the appropriate entry level degrees required for graduation and licensure.

7. Does the practice of Pelvic Floor Therapy require certification, licensure or a minimum number of hours of training in the practice of Physical Therapy?

8. What is the standard of care for Pelvic Floor Therapy in the practice of Physical Therapy?