California Therapy Practice Guide: PT, OT and SLP

For OT, PT and SLP practices in California: three state boards license the disciplines, a patient may start physical therapy without a referral for up to 45 days or 12 visits, Medi-Cal covers children’s therapy under EPSDT and adults within its own rules, and telehealth follows the patient’s location. Every rule here is quoted from its source.⁠^1,2,3,4,5,6

Key takeaways

In California, physical therapists are licensed by the Physical Therapy Board of California, occupational therapists by the California Board of Occupational Therapy and speech-language pathologists by the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board, each under its own practice act and rules.⁠^{1,2,3,4,7,8,9,10,11,12,13,14}
For physical therapy, a patient may begin treatment directly with a licensed physical therapist, who may not continue past 45 calendar days or 12 visits, whichever comes first, without a dated signature approving the plan of care from a physician and surgeon, osteopath or podiatrist.⁠⁵
Medi-Cal covers occupational, physical and speech therapy for children under EPSDT, and its adult coverage follows the limits in its provider manual.⁠^6,15
Telehealth to a patient in California requires authority to practice where the patient is located; the PT Compact, the OT Compact and the ASLP Interstate Compact stand as their commissions state for California.⁠^16,17,18,19
Medicare’s plan of care must be certified by a physician or nonphysician practitioner, and since January 2025 a signed order or referral on file can stand in for that signature on an initial plan delivered within 30 days of the evaluation.⁠²⁰
California’s Health and Safety Code section 123145 requires providers licensed under its clinic, home health, adult day health and hospice statutes that cease operation to keep records at least 7 years after a patient’s discharge, and an unemancipated minor’s at least one year after the minor turns 18 and never less than 7 years; no statute or board rule found on an official page sets a general retention period for a private OT, PT or SLP practice, so the practice writes its own policy at or above those figures.⁠²¹
The business entity is registered with the California Secretary of State, and the practice act’s rules on who may own a therapy entity apply.⁠^22,23
A child under three with a developmental delay is referred to Early Start, which runs separately from an outpatient clinic’s own intake.⁠²⁴

Who licenses OTs, PTs and SLPs in California?

Three boards license the three disciplines in California, and each publishes its own practice act, rules, renewal cycle and continuing-education requirement. A practice that employs more than one discipline keeps three registers, not one.

Discipline	Board	Practice act and rules	Renewal and continuing education	Assistants
Physical therapy	Physical Therapy Board of California	Business and Professions Code sections 2600 to 2696 (the Physical Therapy Practice Act, Division 2, Chapter 5.7); California Code of Regulations, Title 16, Division 13.2	every two years, expiring on the last day of the licensee’s birth month; 30 hours of continuing competency per two-year period for PTs and PTAs alike, including 4 hours of hands-on basic life support and 2 hours of ethics, laws and regulations; 15 hours for a first renewal completed on time	a PTA assists only under a licensed PT, who is responsible at all times for the extent, kind, quality and documentation of the PTA’s services; one PT supervises at most two PTAs at a time⁠^1,2,3,4
Occupational therapy	California Board of Occupational Therapy	Business and Professions Code sections 2570 to 2572 (the Occupational Therapy Practice Act, Division 2, Chapter 5.6); California Code of Regulations, Title 16, Division 39	every two years, expiring on the last day of the licensee’s birth month in odd or even years by birth year; 24 professional development units per two-year period, at least half directly related to delivering occupational therapy services	an OTA practices only under a licensed OT, who is responsible for all services and reviews the OTA’s work at least weekly; one OT supervises at most three OTAs at a time, and a facility’s OTAs may not exceed three times its OTs⁠^7,8,9,10
Speech-language pathology	Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board	Business and Professions Code sections 2530 to 2539.14 (Division 2, Chapter 5.3); California Code of Regulations, Title 16, Division 13.4	every two years, on the last day of the birth month, for the SLP license and for an SLPA registration alike; 24 hours of continuing professional development per two-year period, 12 hours for a first renewal	an SLP needs two years or 3,120 hours of full-time experience before supervising an SLPA, gives on-site observation and guidance for 20 percent of the SLPA’s duties in the first 90 days, may give direct supervision by synchronous audiovisual means, and supervises three support personnel, never more than six⁠^11,12,13,14

Physical therapists and physical therapist assistants answer to the Physical Therapy Board of California.⁠^1,2,3,4 Occupational therapists and occupational therapy assistants answer to the California Board of Occupational Therapy.⁠^7,8,9,10 Speech-language pathologists answer to the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board.⁠^11,12,13,14 A license is a state authorization; a national certification (NBCOT for occupational therapy, the ASHA certificate for speech-language pathology, the NPTE for physical therapy) is a different thing and does not replace it. Compact privileges for practitioners licensed elsewhere are covered under telehealth below.

What does a California license renewal require?

Each board sets its own cycle and hours, listed in the table above, and the register template at the end of this page tracks them per clinician.⁠^{1,2,3,4,7,8,9,10,11,12,13,14} A renewal missed is a lapse, and the board’s own rules say what a lapsed licensee may and may not do; the practice reads those rules before a clinician’s renewal date passes, not after.

Can a patient see a California PT, OT or SLP without a referral?

State law answers this discipline by discipline, and a payer may still require a referral the law does not. For physical therapy, a patient may begin treatment directly with a licensed physical therapist, who may not continue past 45 calendar days or 12 visits, whichever comes first, without a dated signature approving the plan of care from a physician and surgeon, osteopath or podiatrist.⁠⁵ For occupational therapy, the Occupational Therapy Practice Act defines the practice and requires a license to practice it, and carries no provision that conditions an evaluation or treatment on a physician’s referral; Medi-Cal, as a payer, requires a written referral for the services it covers.⁠²⁵ For speech-language pathology, the licensure act defines the practice of speech-language pathology and requires a license, and carries no provision that conditions an evaluation or treatment on a physician’s referral; Medi-Cal requires a written referral from a physician or dentist for the services it covers.⁠²⁶

The payer’s rule is separate. Medicare pays for outpatient therapy under a plan of care certified by a physician or nonphysician practitioner, and the regulation’s 2025 text lets a signed order or referral on file, with the plan delivered within 30 days of the initial evaluation, stand in for that signature on an initial plan.⁠²⁰ Medi-Cal’s referral and prior-authorization rules are in the next section. A commercial plan’s rule is in its member contract and provider manual, and the practice keeps a copy of each.

How does Medi-Cal pay for pediatric and adult therapy?

Medi-Cal is California’s Medicaid program, run by the Department of Health Care Services, and a practice enrolls through its provider enrollment route before it bills.⁠²⁷ For children, the federal EPSDT benefit requires the state to cover services that correct or ameliorate a condition found at a screening, whether or not the state plan covers them for adults.⁠²⁸ For members under 21, Medi-Cal’s provider manual adds EPSDT coverage of occupational, physical and speech therapy when medically necessary, under the broader standard of correcting or ameliorating a condition found at a screening.⁠⁶

For adults, Medi-Cal covers medically necessary occupational and physical therapy for adults only on the written referral of a physician, dentist or podiatrist (for speech therapy, a physician or dentist), limits outpatient visits to two services a month subject to Medi-Service reservations, and applies the adult standard of services reasonable and necessary to protect life, prevent significant illness or disability, or alleviate severe pain.⁠¹⁵ The manuals differ by discipline on authorization: an occupational or speech therapy initial or six-month evaluation needs no Treatment Authorization Request while further services do, whereas every physical therapy service, the evaluations included, needs one, all filed with the TAR Processing Center.⁠²⁹ About 15.2 million Medi-Cal members in all 58 counties receive care through managed care, under five models (Two-Plan, County Organized Health Systems, Geographic Managed Care, Regional Model and Single-Plan), so a practice enrolls with the plans in its county as well as with the state.⁠³⁰ The fee schedule is published by the agency, and a practice reads the current file rather than a remembered rate.⁠³¹

How does Medi-Cal want OT, PT and SLP claims coded?

Medi-Cal’s therapy manuals bill the initial and six-month evaluations under the program’s own HCPCS codes rather than CPT codes: X4108 for occupational therapy, X3924 for physical therapy, and X4300 and X4301 for speech therapy. Outpatient visits by an independent practitioner are limited to two services a month subject to Medi-Service reservations; the speech evaluation codes need no reservation, the occupational therapy evaluation needs no Treatment Authorization Request, and physical therapy services, evaluations included, need one. A speech claim for work by a trainee completing Required Professional Experience carries modifier YW on codes X4300 through X4320, billed by the supervising provider.⁠^{32,33,34,35,36} The codes, modifiers and authorization forms are the manual’s and change with it, so the practice reads the current therapy sections before its first claim and records the manual’s page-updated date in the payer register.

Does Medi-Cal pay for therapy in schools?

The Local Educational Agency Medi-Cal Billing Option Program reimburses school districts, county offices of education, charter schools, state special schools, community college districts and the state university campuses the federal share of the maximum allowable rate for approved health-related services to Medi-Cal-eligible students.⁠³⁷ A school’s billing is the district’s, under its own program; an outpatient clinic’s claim for the same child is a separate matter with its own eligibility and authorization.

Does Medi-Cal cover therapy by telehealth?

Medi-Cal’s telehealth page traces its coverage to the Telehealth Advancement Act of 2011, which let patients consent verbally and let every California-licensed, Medi-Cal-enrolled provider practice by telehealth.⁠³⁸ The telehealth section below covers the state’s own rules for the session itself.

What are California’s telehealth rules for therapy?

A therapist treating a patient by video needs authority to practice where the patient is located at the time of the session, and the federal telehealth site says so plainly: licensure follows the patient’s location, and a compact privilege is one route to it.⁠¹⁶ Business and Professions Code section 2290.5 requires the provider who initiates telehealth to inform the patient and obtain documented verbal or written consent before care, and says telehealth does not authorize care in a setting or manner not otherwise authorized by law, so a practitioner treating a patient located in California needs a California license.⁠^39,40

Compact	California’s status	Source
PT Compact (physical therapy)	not a member: the commission lists California among the ten non-member states	the PT Compact Commission⁠¹⁷
OT Compact (occupational therapy)	not listed among the member states on the commission’s roster of state commissioners	the OT Compact Commission⁠¹⁸
ASLP Interstate Compact (speech-language pathology and audiology)	not listed among the member states on the commission’s roster of delegates	the ASLP-IC Commission⁠¹⁹

A compact privilege is not a national license: it is a privilege to practice in the specific member state that issued it, under that state’s practice act, and a state that has enacted the compact may not yet be issuing privileges, which is why the table names the commission’s current status.⁠¹⁷ Health and Safety Code section 1374.13 bars a health care service plan from requiring in-person contact before it pays for covered services appropriately provided through telehealth and from limiting the setting of those services, and it applies to Medi-Cal managed care plan contracts as well.⁠⁴¹

Which business steps are specific to California?

The entity is registered with the California Secretary of State, and the choice of entity is shaped by the state’s rule on who may own a therapy business.⁠^22,23 Physical therapists, occupational therapists and speech-language pathologists each form a professional corporation under their own practice act, all under the Moscone-Knox Professional Corporation Act, and, with the narrow exceptions the Corporations Code allows, every shareholder, director and officer must be a licensed person.⁠²² State tax registration follows through the Employment Development Department, for an employer.⁠⁴² California taxes the sale of tangible goods, not the performance of a service: its sales and use tax regulation treats a service business as the consumer, not the retailer, of the items it uses incidentally while rendering the service, so tax applies when the clinic buys its supplies, and a practice that regularly sells goods to patients apart from treatment, such as equipment or home exercise products, is a retailer for those sales and must hold a seller’s permit, file returns and remit the tax.⁠⁴³ Every California employer other than the state must secure workers’ compensation, by insuring with an authorized carrier or by a certificate of consent to self-insure, with no minimum number of employees.⁠²³ A city or county business license is a local question, answered by the city hall of the clinic’s address. The startup-costs guide carries the budget worksheet these registrations go into.

What record and privacy rules apply in California?

California’s Health and Safety Code section 123145 requires providers licensed under its clinic, home health, adult day health and hospice statutes that cease operation to keep records at least 7 years after a patient’s discharge, and an unemancipated minor’s at least one year after the minor turns 18 and never less than 7 years; no statute or board rule found on an official page sets a general retention period for a private OT, PT or SLP practice, so the practice writes its own policy at or above those figures.⁠²¹ Two federal periods sit beside it and are often confused with it: Medicare requires 7 years for documentation of orders, certifications, referrals and payment requests, and HIPAA requires 6 years for its own compliance documentation, and neither sets the retention period for the clinical chart.⁠^44,45

The Confidentiality of Medical Information Act (Civil Code section 56.10) bars a provider of health care from disclosing a patient’s medical information without first obtaining an authorization, except as the statute itself allows, a rule that sits beside HIPAA rather than replacing it.⁠⁴⁶ Civil Code section 1798.82 requires a business that owns or licenses computerized personal information to disclose a breach of its security within 30 calendar days of discovery or notification.⁠⁴⁷ Penal Code section 11165.7 makes every person licensed under Division 2 of the Business and Professions Code, which holds the physical therapy, occupational therapy and speech-language pathology practice acts, a mandated reporter of child abuse and neglect.⁠⁴⁸

Which California rules shape a pediatric practice?

Early Start is California’s early-intervention program for infants and toddlers with developmental delays or at risk of a developmental disability, run statewide by the Department of Developmental Services in a family-centered system; families and clinicians reach it through the Early Start Baby Line.⁠²⁴ A child who turns three moves from early intervention to the school district’s evaluation, and a private clinic’s services run beside both systems rather than inside them. Health and Safety Code section 1374.73 requires every health care service plan contract with hospital, medical or surgical coverage to cover behavioral health treatment for pervasive developmental disorder or autism and to keep an adequate network of qualified autism service providers; the statute names behavioral health treatment rather than occupational, physical or speech therapy, states no age or dollar cap, and does not reach Medi-Cal managed care contracts.⁠⁴⁹ The autism insurance mandates guide covers how such a mandate meets a plan’s own terms. California Children’s Services’ Medical Therapy Program provides physical therapy, occupational therapy and medical therapy conferences for children with disabling conditions, mostly neurological or musculoskeletal, with no financial eligibility requirement and no charge to the family.⁠⁵⁰

Which California rules shape an adult practice?

Medicare claims from California go to Noridian Healthcare Solutions, the Medicare Administrative Contractor for Jurisdiction E, Part B (California, Hawaii, Nevada and the Pacific territories), whose local coverage articles for therapy are the ones a California practice reads.⁠⁵¹ Medi-Cal’s adult therapy rules are in the Medicaid section above. The Division of Workers’ Compensation’s Official Medical Fee Schedule for physician services also covers physical therapists and occupational therapists among non-physician practitioners; its page does not name speech-language pathologists.⁠⁵²

Where do California therapists find their associations and the directory?

The state chapters are the California Physical Therapy Association for physical therapy, the Occupational Therapy Association of California for occupational therapy and the California Speech-Language-Hearing Association for speech-language pathology.⁠^53,54,55 On DrSensory, families browse California clinics by discipline on the occupational therapy, physical therapy and speech therapy pages for the state, which the directory builds from the clinic addresses it holds; a clinic appears on the pages of its own address.⁠⁵⁶

Which California cities have DrSensory city pages?

Beyond its three California pages, the directory publishes city pages for 20 California cities, 55 pages across the three disciplines, each listing the clinics whose address is in that city; a clinic appears on the city page of its address without any action of its own, and a city or discipline without a page is reached through the state page.⁠⁵⁶

City	Occupational therapy	Physical therapy	Speech therapy
Anaheim	occupational therapy in Anaheim	physical therapy in Anaheim	speech therapy in Anaheim
Bakersfield	occupational therapy in Bakersfield	physical therapy in Bakersfield	speech therapy in Bakersfield
Chula Vista	occupational therapy in Chula Vista	physical therapy in Chula Vista	speech therapy in Chula Vista
Fresno	occupational therapy in Fresno	physical therapy in Fresno	speech therapy in Fresno
Glendale	occupational therapy in Glendale	physical therapy in Glendale	speech therapy in Glendale
Huntington Beach	occupational therapy in Huntington Beach	physical therapy in Huntington Beach	speech therapy in Huntington Beach
Irvine	occupational therapy in Irvine	physical therapy in Irvine	speech therapy in Irvine
Long Beach	occupational therapy in Long Beach	physical therapy in Long Beach	speech therapy in Long Beach
Los Angeles	occupational therapy in Los Angeles	physical therapy in Los Angeles	speech therapy in Los Angeles
Modesto	state page	physical therapy in Modesto	speech therapy in Modesto
Oakland	occupational therapy in Oakland	physical therapy in Oakland	speech therapy in Oakland
Riverside	occupational therapy in Riverside	physical therapy in Riverside	speech therapy in Riverside
Sacramento	occupational therapy in Sacramento	physical therapy in Sacramento	speech therapy in Sacramento
San Bernardino	occupational therapy in San Bernardino	physical therapy in San Bernardino	speech therapy in San Bernardino
San Diego	occupational therapy in San Diego	physical therapy in San Diego	speech therapy in San Diego
San Francisco	occupational therapy in San Francisco	physical therapy in San Francisco	speech therapy in San Francisco
San Jose	occupational therapy in San Jose	physical therapy in San Jose	speech therapy in San Jose
Santa Ana	occupational therapy in Santa Ana	physical therapy in Santa Ana	speech therapy in Santa Ana
Santa Clarita	state page	physical therapy in Santa Clarita	state page
Stockton	state page	physical therapy in Stockton	state page

Where does each requirement come from, and what does the practice do?

Requirement	Where it comes from	What the practice does	Source
A license for each clinician	Physical Therapy Board of California, California Board of Occupational Therapy, Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board	Verify every license on the board’s site and enter its renewal date in the register	^{1,2,3,4,7,8,9,10,11,12,13,14}
Referral or direct access	The practice act for each discipline	Set the intake rule per discipline; keep the payer’s rule beside it	^5,25,26
Medicaid enrollment and coverage	the Department of Health Care Services	Enroll, read the provider manual’s therapy sections, note the authorization vendor	^6,27
Medicare plan of care	42 CFR 424.24	Certify every plan, or hold the signed order or referral on file with the plan delivered within 30 days	²⁰
Telehealth across a state line	The patient’s state and the compacts	Confirm the patient’s location each session; hold a license or a privilege there	^16,17
The business entity	the California Secretary of State	Choose the entity the practice act allows and register it	^22,23
Record retention	State law, Medicare and HIPAA	Keep the longest period that applies, with the rule for minors	^21,44

Which templates does a California launch need?

California launch checklist. Each line names its source so the practice can re-read the rule when it changes.

Physical therapy licenses verified with the Physical Therapy Board of California; renewal dates and continuing-education hours entered in the register
Occupational therapy licenses verified with the California Board of Occupational Therapy; the same
Speech-language pathology licenses verified with the Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board; the same
The intake rule for referrals set per discipline from the practice act, with the payer’s rule beside it
Medi-Cal enrollment filed; the provider manual’s therapy sections and the authorization vendor noted
Medicare enrollment and the plan-of-care routine in place
Telehealth: the patient-location check at every session; licenses or compact privileges for every state served
The entity registered with the California Secretary of State; the ownership rule read
The state’s sales-tax rule on services and on goods sold to patients read; a seller’s permit where the practice sells goods
Record retention set to the longest period that applies; the minors’ rule noted
The early-intervention and school pathways known to intake, with the referral routes
The Medicare contractor’s therapy articles bookmarked
The state association memberships decided

License and renewal register. One line per clinician.

Clinician: [their name]
Discipline and board: [physical therapy, occupational therapy or speech-language pathology; the board]
License number: [as the board lists it]
Renewal date: [the date]
Continuing-education hours due and completed: [hours due by the board’s rule; hours completed to date]
Compact privileges held: [the states and the privilege numbers, if any]
Checked on the board’s site: [the date and by whom]

Payer register. One line per payer the practice bills.

Payer: [Medi-Cal, a managed care plan, Medicare through Noridian Healthcare Solutions, a commercial plan]
Enrollment or contract status and effective date: [the status; the date]
Referral rule: [what the payer requires]
Authorization rule and vendor: [what needs authorization; who issues it]
Telehealth rule: [covered services and modifiers]
Fee schedule location and date read: [where; when]
Owner: [who keeps this line current]

How might two California practices plan a launch?

A pediatric occupational therapy practice in Los Angeles. Hypothetical; a planning exercise, not a claim about demand in Los Angeles.

Licensing: the owner and one occupational therapy assistant are verified with the California Board of Occupational Therapy; the assistant’s supervision rule from the board goes into the staffing plan.
Referrals: the practice act’s rule for occupational therapy sets the intake script; Medi-Cal’s referral and authorization rules sit beside it, since most of the first families are enrolled through a managed care plan.
Medicaid: enrollment is filed before the first family is scheduled; the authorization vendor’s turnaround becomes the scheduling lead time.
Early intervention: families with children under three are told how the referral to Early Start works and that the clinic’s services run beside it.
Records: the state’s retention rule for minors sets the chart policy on day one.

An adult physical therapy practice in San Diego. Hypothetical; a planning exercise, not a claim about demand in San Diego.

Licensing: two physical therapists verified with the Physical Therapy Board of California; one holds a PT Compact privilege for a neighboring state, which the telehealth policy records.
Referrals: the practice act’s direct-access rule sets the intake script; Medicare’s plan-of-care routine is written before the first Medicare patient, with the signed order or referral held on file where the referring practitioner sends one.
Medicare: enrollment through the Noridian Healthcare Solutions; the contractor’s therapy articles are read for the codes the practice bills.
Telehealth: the patient-location check is part of every video session’s note; a patient who travels out of state is seen only where the practice holds authority.
Business: the entity is registered with the California Secretary of State in the form the practice act allows, and the local business license is filed with the city.

Frequently asked questions

Can I practice in California on a compact privilege from another state?

Only as the compact’s commission states for California: the table above gives each compact’s status, and a privilege is issued for a specific member state under that state’s practice act, not as a national license.⁠^17,18,19

Does Medi-Cal cover therapy for adults?

Within its own rules: the provider manual sets what is covered for adults, with the limits and authorization requirements quoted in the Medicaid section, while children’s coverage runs under EPSDT.⁠^15,28

Do patients in California need a referral before therapy?

The practice act answers per discipline and the referral section quotes each rule; a payer may still require a referral or a certified plan of care the law does not, so the intake script carries both rules.⁠^5,20

Can I treat a California patient by telehealth from another state?

Only with authority to practice in California, since licensure follows the patient’s location; a compact privilege is one route where the compact is live for the state.⁠^16,17

How long must a California practice keep therapy records?

No statute or board rule found sets a general period for a private OT, PT or SLP practice; the one retention statute on the books, Health and Safety Code section 123145, binds certain licensed facilities that cease operation to 7 years after discharge and, for a minor, at least one year past age 18 and never less than 7 years, which is the floor a practice policy follows.⁠²¹ Medicare’s 7-year and HIPAA’s 6-year rules cover other documents and do not shorten it.⁠^44,45

Which entity can a California therapy practice form?

A professional corporation under the discipline’s own practice act and the Moscone-Knox Professional Corporation Act, with licensed persons as its shareholders, directors and officers except where the Corporations Code allows otherwise.⁠²² The Secretary of State’s registration follows the choice.⁠^22,23

How is a young child referred to early intervention in California?

Through Early Start, the Department of Developmental Services’ statewide program for infants and toddlers with developmental delays or at risk of a developmental disability; the Early Start Baby Line takes referrals.⁠²⁴

Where do families find California therapy clinics on DrSensory?

On the state’s occupational therapy, physical therapy and speech therapy pages and on the city pages listed above, built from the clinic addresses the directory holds; a clinic’s listing appears on the pages of its own address, and a paid listing adds the clinic’s own description, hours and specialties.⁠^56,57

Sources

California. Physical Therapy Board of California (the physical therapy licensing board's page). Checked October 26, 2026.
Physical Therapy Board of California. License Renewal (the physical therapy licensing board's page). “A license to practice physical therapy must be renewed every two years. The expiration date is the last day of the licensee’s birth month.” Checked October 26, 2026.
Physical Therapy Board of California. Continuing Competency (the physical therapy licensing board's page). Checked October 26, 2026.
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“Physical Therapists and Physical Therapist Assistants are subject to the same continuing competency requirements. ... [Not a New Licensee, Before OR After the Expiration Date] 4 Hours (Hands-on required) [BLS] / 2 Hours [Ethics, Laws and Regulations] / 24 Hours [Other] / 30 Hours Total Required.”
California Legislative Information (Office of Legislative Counsel). Business and Professions Code sections 2622(b) and 2630.3 (the physical therapy licensing board's page). Checked October 26, 2026.
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“A licensed physical therapist assistant holding a valid, unexpired, and unrevoked physical therapist assistant license may assist in the provision of physical therapy services only under the supervision of a physical therapist licensed by the board. A licensed physical therapist shall at all times be responsible for the extent, kind, quality, and documentation of all physical therapy services provided by the physical therapist assistant. ... A physical therapist shall not supervise more than two physical therapist assistants at one time to assist the physical therapist in his or her practice of physical therapy.”
California Legislative Information (Office of Legislative Counsel). Business and Professions Code section 2620.1 (the practice act on referral and direct access). Checked October 26, 2026.
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“In addition to receiving those services authorized by Section 2620, a person may initiate physical therapy treatment directly from a licensed physical therapist if the treatment is within the scope of practice... The physical therapist shall not continue treating the patient beyond 45 calendar days or 12 visits, whichever occurs first, without receiving, from a person holding a physician and surgeon’s certificate... a dated signature on the physical therapist’s plan of care indicating approval of the physical therapist’s plan of care.”
California Department of Health Care Services. Medi-Cal Provider Manual, Part 2, Occupational Therapy (the Medicaid provider manual on therapy for children). Checked October 26, 2026.
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“Additional OT services for Medi-Cal members under 21 years of age may be available pursuant to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit when medically necessary. ... For Medi-Cal members under 21 years of age, a service is "medically necessary" or a "medical necessity" if it will correct or ameliorate defects and physical and mental illnesses and conditions discovered through screening.”
California. California Board of Occupational Therapy (the occupational therapy licensing board's page). Checked October 26, 2026.
California Board of Occupational Therapy. Renewal Information - Board of Occupational Therapy (the occupational therapy licensing board's page). “The term of a license or certificate is two years. Licenses and certificates expire at midnight on the last day of your birth month in odd or even years depending on your birth year.” Checked October 26, 2026.
California Board of Occupational Therapy. Continuing Competency - Board of Occupational Therapy (the occupational therapy licensing board's page). Checked October 26, 2026.
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“The Board transitioned from an annual to a biennial renewal. As of January 2009, all renewing practitioners will need to complete 24 PDUs. ... One half (1/2) of the required number of PDUs must be directly related to the delivery of occupational therapy services.”
California Legislative Information (Office of Legislative Counsel). Business and Professions Code section 2570.3 (the occupational therapy licensing board's page). Checked October 26, 2026.
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““Supervision of an occupational therapy assistant” means that the responsible occupational therapist shall at all times be responsible for all occupational therapy services provided to the client. ... the occupational therapist shall conduct at least weekly review and inspection of all aspects of occupational therapy services by the occupational therapy assistant. ... Three occupational therapy assistants shall be the maximum number of occupational therapy assistants supervised by an occupational therapist at any one time ... In no case shall the total number of occupational therapy assistants exceed three times the number of occupational therapists regularly employed by a facility at any one time.”
California. Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board (the speech-language pathology licensing board's page). Checked October 26, 2026.
Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board. Renew License (the speech-language pathology licensing board's page). “Speech-Language Pathologist / 2 Years / Last day of birth month. ... Speech Language Pathology Assistant / 2 Years / Last day of birth month.” Checked October 26, 2026.
Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board. Speech, Audiology, & Dispensing Audiologist Reqs (the speech-language pathology licensing board's page). “Speech-Language Pathologist or Audiologist [subsequent renewal]: 24 hours [total hours required]. ... Speech-Language Pathologist or Audiologist (first renewal): 12 hours.” Checked October 26, 2026.
Speech-Language Pathology and Audiology and Hearing Aid Dispensers Board. SLP Assistant Supervision Reqs (the speech-language pathology licensing board's page). Checked October 26, 2026.
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“To protect the public, the Board set standards and requirements for the adequate supervision of a speech–language pathology assistant (SLPA) pursuant to Business and Professions Code section 2538.1. This regulatory change will additionally require any speech–language pathology (SLP) who wish to supervise a SLPA to: Have two (2) years of full–time experience or 3,120 hours providing services as a licensed or credentialed SLP before supervising a SLPA, Provide direct supervision that consists of on–site observation and guidance for twenty (20) percent of all duties for the first ninety (90) days of initial licensure ... This regulatory change will permit SLPA supervisors to: Provide direct supervision through synchronous audiovisual, and Supervise three (3) support personnel not to exceed six (6) at any time.”
California Department of Health Care Services. Medi-Cal Provider Manual, Part 2, Occupational Therapy (the Medicaid provider manual on therapy for adults). Checked October 26, 2026.
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“Medi-Cal covers medically necessary OT services when ordered on the written referral of a physician, dentist or podiatrist and rendered by a qualified Medi-Cal provider within their scope of practice. ... For Medi-Cal members over age 21, medically necessary services are those services that “are reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain through the diagnosis and treatment of disease, illness or injury” (CCR, Title 22, Section 51303). ... OT services rendered in an outpatient setting are limited to a maximum of two services per month subject to the availability of Medi-Service reservations.”
U.S. Department of Health and Human Services. Getting started with licensure (Telehealth.HHS.gov, last updated February 21, 2024). Checked October 26, 2026.
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“Health professionals must meet the licensure requirements of the state where they are located and be licensed or legally permitted to practice in the state where the patient is located”. Its companion page, Licensing across state lines (last updated April 30, 2025): “The ability to deliver health care services across state lines varies based on state regulations”; “Prior to an appointment, providers should verify patient location and obtain consent”; “Compacts allow participating health care providers to practice in participating states”.
PT Compact Commission. PT Compact Map (the PT Compact Commission's state page). “Member States (38): Alabama, Alaska, Arizona... [not including California]. ... Non-Members (10): California, Florida, Hawaii, Idaho...” Checked October 26, 2026.
Occupational Therapy Compact Commission. State Commissioners (the OT Compact Commission's state page). Checked October 26, 2026.
Audiology and Speech-Language Pathology Interstate Compact Commission. Delegate Information (the ASLP-IC Commission's state page). Checked October 26, 2026.
Code of Federal Regulations. 42 CFR 424.24, Requirements for medical and other health services furnished by providers under Medicare Part B (eCFR, up to date as of October 22, 2026; paragraph (c), outpatient physical therapy, occupational therapy and speech-language pathology services). Checked October 26, 2026.
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“The individual needs, or needed, physical therapy, occupational therapy, or speech-language pathology services.”; “The services were furnished while the individual was under the care of a physician, nurse practitioner, clinical nurse specialist, or physician assistant.”; “The initial certification must be obtained as soon as possible after the plan is established.”; “Recertification is required at least every 90 days.”; “When it is recertified, the plan or other documentation in the patient’s record must indicate the continuing need for physical therapy, occupational therapy or speech-language pathology services.”; “the therapist has documented evidence that the plan of treatment has been delivered to the physician, NP, PA, or CNS within 30 days of completion of the initial evaluation, the certification does not need to be signed by a physician, NP, CNS, or PA who has knowledge of the case.”; “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.”.
California Legislative Information (Office of Legislative Counsel). Health and Safety Code section 123145 (the state's record-retention rule). Checked October 26, 2026.
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“Providers of health services that are licensed pursuant to Sections 1205, 1253, 1575 and 1726 have an obligation, if the licensee ceases operation, to preserve records for a minimum of seven years following discharge of the patient, except that the records of unemancipated minors shall be kept at least one year after the minor has reached the age of 18 years, and in any case, not less than seven years.”
California Legislative Information (Office of Legislative Counsel). Business and Professions Code sections 2690 to 2696 (physical therapy corporations; sections 2572 and 2536 to 2537.5 hold the parallel occupational therapy and speech-language pathology provisions) (the statute on professional entities). Checked October 26, 2026.
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“A physical therapy corporation is a corporation that is authorized to render professional services, as defined in Section 13401 of the Corporations Code, so long as that corporation and its shareholders, officers, directors, and employees rendering professional services who are physical therapists are in compliance with the Moscone-Knox Professional Corporation Act... Except as provided in Section 13403 of the Corporations Code, each shareholder, director and officer of a physical therapy corporation... shall be a licensed person as defined in Section 13401 of the Corporations Code.”
California Legislative Information (Office of Legislative Counsel). Labor Code section 3700 (the workers' compensation agency's rule for employers). Checked October 26, 2026.
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“Every employer except the state shall secure the payment of compensation in one or more of the following ways: (a) By being insured against liability to pay compensation by one or more insurers duly authorized to write compensation insurance in this state. (b) By securing from the Director of Industrial Relations a certificate of consent to self-insure...”
California Department of Developmental Services. Early Start (the Part C early-intervention program's page). Checked October 26, 2026.
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“The Early Start (ES) program is California’s early intervention program for infants and toddlers with developmental delays or at risk for having a developmental disability and their families. Early Start services are available statewide and are provided in a coordinated, family-centered system. ... For more info on Early Start services & referrals, please contact the Early Start Baby Line at 800-515-BABY (800-515-2229) or earlystart@dds.ca.gov.”
California Legislative Information (Office of Legislative Counsel). Business and Professions Code sections 2570.2 and 2570.3 (the practice act on referral). Checked October 26, 2026.
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““Occupational therapy” means the therapeutic use of purposeful and meaningful goal-directed activities (occupations) with individuals, groups, populations, or organizations, to support participation, performance, and function... A person shall not practice occupational therapy or hold themselves out as an occupational therapist... unless the person is licensed as an occupational therapist under the provisions of this chapter.”
California Legislative Information (Office of Legislative Counsel). Business and Professions Code section 2530.2 (the practice act on referral). Checked October 26, 2026.
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“The practice of speech-language pathology means all of the following: (1) The application of principles, methods, instrumental procedures, and noninstrumental procedures for measurement, testing, screening, evaluation, identification, prediction, and counseling related to the development and disorders of speech, voice, language, or swallowing. (2) The application of principles and methods for preventing, planning, directing, conducting, and supervising programs for habilitating, rehabilitating, ameliorating, managing, or modifying disorders of speech, voice, language, or swallowing...”
California Department of Health Care Services. Provider Enrollment Division (the Medicaid provider enrollment page). Checked October 26, 2026.
Medicaid.gov (Centers for Medicare & Medicaid Services). Early and Periodic Screening, Diagnostic, and Treatment (Medicaid benefit page). Checked October 26, 2026.
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“The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.”; “It is the responsibility of states to determine medical necessity on a case-by-case basis.”.
California Department of Health Care Services. Medi-Cal Provider Manual, Part 2, Occupational Therapy and Physical Therapy (the Medicaid prior authorization rule). Checked October 26, 2026.
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“[OT] OT services rendered in an outpatient setting are limited to a maximum of two services per month subject to the availability of Medi-Service reservations. Initial and six-month evaluations do not require a TAR. TARs for OT services for Medi-Cal members must be submitted to the TAR Processing Center. [PT, by contrast] All PT services rendered in an outpatient setting are limited to a maximum of two services per month... PT services (including initial and six-month evaluations) require a TAR.”
California Department of Health Care Services. Medi-Cal Managed Care (the Medicaid agency on managed care). “Today, approximately 15.2 million Medi-Cal members in all 58 counties receive their health care through five main models of managed care: Two-Plan, County Organized Health Systems (COHS), Geographic Managed Care (GMC), Regional Model (RM), and Single-Plan.” Checked October 26, 2026.
California Department of Health Care Services. Medi-Cal Rates (the Medicaid fee schedule page). Checked October 26, 2026.
California Department of Health Care Services. Medi-Cal Provider Manual, Part 2, Speech Therapy (page updated June 2026) (the Medicaid provider manual on therapy claim codes and modifiers). Checked October 26, 2026.
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“ST services rendered in an outpatient setting are limited to a maximum of two services per month subject to the availability of Medi-Service reservations. Initial and six-month evaluations (HCPCS codes X4300 and X4301) do not require a Medi-Service reservation.”
California Department of Health Care Services. Medi-Cal Provider Manual, Part 2, Occupational Therapy (page updated June 2026) (the Medicaid provider manual on therapy claim codes and modifiers). “Initial and six-month evaluations billed under HCPCS code X4108 (occupational therapy preliminary evaluation rehabilitation, Nursing Facility [NF] Level A, Level B) do not require a TAR” Checked October 26, 2026.
California Department of Health Care Services. Medi-Cal Provider Manual, Part 2, Physical Therapy (page updated June 2026) (the Medicaid provider manual on therapy claim codes and modifiers). Checked October 26, 2026.
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“Initial and six-month evaluations (HCPCS code X3924) require only that the Medi-Cal member be eligible for Medi-Cal the month the service is performed, on the written referral of a physician, dentist or podiatrist”
California Department of Health Care Services. Medi-Cal Provider Manual, Part 2, Physical Therapy (page updated June 2026) (the Medicaid provider manual on therapy claim codes and modifiers). Checked October 26, 2026.
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“All PT services rendered in an outpatient setting are limited to a maximum of two services per month subject to the availability of Medi-Service reservations. PT services (including initial and six-month evaluations) require a TAR.”
California Department of Health Care Services. Medi-Cal Provider Manual, Part 2, Speech Therapy (page updated June 2026) (the Medicaid provider manual on therapy claim codes and modifiers). Checked October 26, 2026.
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“The supervising provider must bill for the services and enter the RPE trainee’s provider number in the Additional Claim Information field (Box 24K) of the claim. Providers billing for services performed by an RPE trainee must add modifier YW to HCPCS codes X4300 thru X4320 for ST services.”
California Department of Health Care Services. Local Educational Agency Medi-Cal Billing Option Program (the Medicaid agency on school-based services). Checked October 26, 2026.
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“The Local Educational Agency Medi-Cal Billing Option Program (LEA BOP) reimburses LEA BOP Providers (school districts, county offices of education, charter schools, state special schools, community college districts, California State Universities, and University of California campuses) the federal share of the maximum allowable rate for approved health-related services provided by qualified health service practitioners to Medi-Cal eligible students.”
California Department of Health Care Services. Medi-Cal & Telehealth (the Medicaid agency on telehealth). Checked October 26, 2026.
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“The passage of the Telehealth Advancement Act (AB 415) in 2011 laid the foundation for Medi-Cal to drastically expand coverage of telehealth in Medi-Cal, eliminating the ban on email and telephone-delivered services, permitting patients to verbally consent to telehealth, and enabling all California-licensed and Medi-Cal enrolled providers to practice via telehealth.”
California Legislative Information (Office of Legislative Counsel). Business and Professions Code section 2290.5(e) (the state's telehealth statute or rule). “This section does not alter the scope of practice of a health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law.” Checked October 26, 2026.
California Legislative Information (Office of Legislative Counsel). Business and Professions Code section 2290.5(b) (the state's telehealth statute or rule). Checked October 26, 2026.
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“Before the delivery of health care via telehealth, the health care provider initiating the use of telehealth shall inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health. The consent shall be documented.”
California Legislative Information (Office of Legislative Counsel). Health and Safety Code section 1374.13 (the state's telehealth coverage law). Checked October 26, 2026.
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“A health care service plan shall not require that in-person contact occur between a health care provider and a patient before payment is made for the covered services appropriately provided through telehealth... A health care service plan shall not limit the type of setting where services are provided for the patient or by the health care provider before payment is made for the covered services appropriately provided through telehealth... This section shall also apply to health care service plan contracts and Medi-Cal managed care plan contracts.”
California Employment Development Department. Am I Required to Register as an Employer? (the state tax registration page). Checked October 26, 2026.
California Department of Tax and Fee Administration. Regulation 1501, Service Enterprises Generally (the state revenue agency's rule on sales tax for services). Checked October 26, 2026.
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“Persons engaged in the business of rendering service are consumers, not retailers, of the tangible personal property which they use incidentally in rendering the service. Tax, accordingly, applies to the sale of the property to them. If in addition to rendering service they regularly sell tangible personal property to consumers, they are retailers with respect to such sales and they must obtain permits, file returns and remit tax measured by such sales.”
Code of Federal Regulations. 42 CFR 424.516, Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program (eCFR, up to date as of October 22, 2026; paragraph (f), Maintaining and providing access to documentation). Checked October 26, 2026.
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“A provider or a supplier that furnishes covered ordered, certified, referred, or prescribed Part A or B services, items or drugs is required to—”; “Maintain documentation (as described in paragraph (f)(1)(ii) of this section) for 7 years from the date of service; and”; “Upon the request of CMS or a Medicare contractor, to provide access to that documentation”; “The documentation includes written and electronic documents (including the NPI of the physician or, when permitted, other eligible professional who ordered, certified, referred, or prescribed the Part A or B service, item, or drug) relating to written orders, certifications, referrals, prescriptions, and requests for payments for Part A or B services, items or drugs.”.
Code of Federal Regulations. 45 CFR 164.316, Policies and procedures and documentation requirements (eCFR, up to date as of October 22, 2026; HIPAA Security Rule; paragraph (b)). Checked October 26, 2026.
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“Maintain the policies and procedures implemented to comply with this subpart in written (which may be electronic) form; and”; “If an action, activity or assessment is required by this subpart to be documented, maintain a written (which may be electronic) record of the action, activity, or assessment.”; “Retain the documentation required by paragraph (b)(1) of this section for 6 years from the date of its creation or the date when it last was in effect, whichever is later.”.
California Legislative Information (Office of Legislative Counsel). Civil Code section 56.10 (the state's health privacy law). Checked October 26, 2026.
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“A provider of health care, health care service plan, or contractor shall not disclose medical information regarding a patient of the provider of health care or an enrollee or subscriber of a health care service plan without first obtaining an authorization, except as provided in subdivision (b) or (c).”
California Legislative Information (Office of Legislative Counsel). Civil Code section 1798.82 (the state's breach-notification statute). Checked October 26, 2026.
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“An individual or business that conducts business in California, and that owns or licenses computerized data that includes personal information, shall disclose a breach of the security of the system following discovery or notification of the breach... The disclosure required by this subdivision shall be made within 30 calendar days of discovery or notification of the data breach.”
California Legislative Information (Office of Legislative Counsel). Penal Code section 11165.7 (the state's mandated-reporter statute). Checked October 26, 2026.
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“As used in this article, “mandated reporter” is defined as any of the following: ... A physician and surgeon, psychiatrist, psychologist, dentist, resident, intern, podiatrist, chiropractor, licensed nurse, dental hygienist, optometrist, marriage and family therapist, clinical social worker, professional clinical counselor, or any other person who is currently licensed under Division 2 (commencing with Section 500) of the Business and Professions Code.”
California Legislative Information (Office of Legislative Counsel). Health and Safety Code section 1374.73 (the state's autism insurance mandate). Checked October 26, 2026.
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“Every health care service plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012. ... Every health care service plan subject to this section shall maintain an adequate network that includes qualified autism service providers who supervise or employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment.”
California Department of Health Care Services. Medical Therapy Program (the program for children with special health care needs). Checked October 26, 2026.
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“The Medical Therapy Program (MTP) is a special program within California Children’s Services (CCS) that provides physical therapy (PT), occupational therapy (OT), and Medical Therapy Conference (MTC) services for children who have disabling conditions, generally due to neurological or musculoskeletal disorders. ... There is no financial eligibility requirement for the MTP... There is never a charge to a family for therapy services under the MTP.”
Noridian Healthcare Solutions. Jurisdiction E - Part B (CMS's contractor map). “Jurisdiction E - Medicare Part B. California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands.” Checked October 26, 2026.
California Department of Industrial Relations, Division of Workers’ Compensation. DWC Official Medical Fee Schedule (the workers' compensation fee schedule). Checked October 26, 2026.
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“Labor Code section 5307.1 requires the DWC administrative director to adopt an official medical fee schedule for physician services. ... The physician fee schedule also covers services of non-physician practitioners, such as physical therapists, occupational therapists, nurse practitioners, physician assistants, clinical social workers, clinical nurse specialists, nurse anesthetists, and anesthesiologist assistants.”
the California Physical Therapy Association. the California Physical Therapy Association (the state association's site). Checked October 26, 2026.
the Occupational Therapy Association of California. the Occupational Therapy Association of California (the state association's site). Checked October 26, 2026.
the California Speech-Language-Hearing Association. the California Speech-Language-Hearing Association (the state association's site). Checked October 26, 2026.
DrSensory. Occupational therapy clinics in California, with the physical therapy and speech therapy pages for the state (the directory's state pages, built from the addresses it holds). Checked October 26, 2026.
DrSensory. Clinic Directory Pricing (the DrSensory pricing page). “$29.99/month” Checked October 26, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy practice in California, not legal, compliance, billing or financial advice. Rules change; the practice confirms each with its source before acting on it.

California therapy practice guide: PT, OT and SLP