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May 29, 2020

Do I Need a Referral to See a Physical Therapist?

do i need a referral to see a physical therapist

In an insightful survey, the American Physical Therapy Association (APTA) uncovered that nearly 70% of people still think a referral is necessary to receive physical therapy. However, since 2015, the Unites States, Virgin Islands, and District of Columbia began allowing patients to see a physical therapist without requiring a prescription from a medical professional.

On August 16, 2018, the Illinois Physical Therapy Act also permitted Illinois residents to see a physical therapist without a referral. Illinois was the 27th state to adopt the practice, joining other states already allowing unrestricted access, such as Iowa.

Traditionally, seeing a physical therapist required sifting through arduous red tape. Direct access to physical therapy has paved the way for receiving immediate assistance, helping patients take steps towards returning to normal activity, slowing down progressive injuries, encouraging chronic pain recovery, and providing higher levels of health care accessibility.

While the fundamental necessity to receive a referral has diminished, states and insurance providers enforce unique provisions. In the content below, we discuss how to determine if you qualify for physical therapy, without a referral, based on insurance provider and state.

What is “Direct Access Physical Therapy?”

see physical therapist without referral

“Direct access physical therapy” describes physical therapy treatment without the referral of a medical provider. Direct access physical therapy saves patients time, money, and ultimately, reduces overall recovery time. With the goal of beginning treatment sooner, early intervention may help patients avoid incurring more serious injuries. Furthermore, direct access to physical therapy provides easy access to pain alleviation. Physical therapy is a healthy, natural route for pain relief, an alternative to illegal medication.

Although the entire country has adopted some level of direct access, it is still a relatively new concept in many states. Most still enforce specific qualifications for direct physical therapy treatment eligibility.

Does My Insurance Allow Direct Access?

Concerning patients in Illinois, you should consider the following specifications and guidelines:

  • At the time of writing, nearly all insurance companies allow direct access including: Blue Cross Blue Shield, United Healthcare, Aetna, Cigna, auto insurance coverage, personal injury coverage, and various out-of-network plans.  Our therapists work with your primary healthcare provider to meet Medicare’s requirements to be seen without a referral.
  • At the time of writing, a prescription may be required for: worker’s compensation coverage, Tricare, and Medicaid. 

If you have specific questions about your insurance, let us know and we are happy to verify you are covered. Of course you may want to get in touch with your insurance provider to see if the company covers your needed care without a referral.   

Does My State Allow Direct Physical Therapy Access?

state allow direct physical therapy access without referral

Although all 50 states enjoy a level of referral-free access to physical therapy, direct access is governed on a state-by-state level. Additionally, some only allow direct access with particular provisions.

The APTA provides a helpful guideline, outlining three levels of access by jurisdiction.

States with Limited Patient Access

Limited patient access states allow for direct access to physical therapy treatment under specific circumstances.

Alabama
Missouri
Mississippi

States with Provisional Patient Access

Patients in these states have access to provisional direct access in accordance to specific provisions such as visit limits or referrals for specific treatments.

Arkansas
California
Connecticut
Delaware
District of Columbia
Florida
Georiga

Indiana
Illinois
Kansas
Louisiana
Maine
Michigan
Minnesota

New Hampshire
New Jersey
New Mexico
New York
Ohio Oklahoma
Pennsylvania
Rhode Island

South Carolina
Tennessee
Texas
US Virgin Islands
Washington
Wisoconsin

States with Unrestricted Patient Access

These states enforce nearly no limitations for treatment without a referral, allowing for true “direct access.” While largely unrestricted, certain states still require physician referral, depending on treatment methodology. For example, Arizona requires the referral of a healthcare professional for wound care, debridement, and bronchopulmonary hygiene.

Alaska
Arizona
Colorado
Hawaii
Idaho
Iowa
Kentucky
Maryland
Massachusetts
Montana

Nebraska
Oregon
South Dakota
Utah
Vermont
West Virginia
Wyoming
Nevada
North Carolina
North Dakota

Important Direct Access Considerations

Many states require that the health care provider receive a written and/or oral plan of care within fifteen days of physical therapy intervention. In some cases, licenses can be revoked if the physical therapist does not refer a patient to an appropriate health care professional if a client’s needs surpass the scope of physical therapy.

In general, most referral guidelines include five primary restrictions:

  • Time spent with a physical therapist, per visit
  • Number of treatments allowed, based on a specific issue
  • Medical care provider requirements for certain diagnoses
  • Patient’s population; may lead to limited physical therapy access
  • Advanced or extended care may require a referral

A complete list of direct access provisions by state (written by the APTA) provides a comprehensive guide!

Is it Safe to See a Physical Therapist Without a Referral?

In short, it is safe to visit a physical therapist without a referral. Although certain states restrict advanced physical therapy care without a medical referral, physical therapists are trained to treat patients without one.

Physical therapists undergo comprehensive and rigorous education requirements before practicing. For example, physical therapists must complete a graduate degree from an accredited academic program (typically a doctoral program), pass the National Physical Therapy Examination, and receive licensure in their state of practice. Certain jurisdictions require supplementary requirements.

Therefore, physical therapy professionals are trained to thoroughly examine and engage in therapeutic intervention for individuals with a variety of limitations. In many cases, treatment without a referral is safe and beneficial.

Is Malpractice Common Among Physical Therapists?

If a physical therapist determines that PT is not the proper treatment for a client’s condition, the therapist will immediately refer the patient to the proper medical professional for appropriate support. Malpractice or complaints of inadequate care are rarely heard among physical therapy practices.

Begin Your Recovery with Rock Valley Physical Therapy

At Rock Valley Physical Therapy, we are committed to helping you get better. Serving Midwestern communities, we are a patient-centered, therapist-led organization, dedicated to taking care of you during current challenges.

We are proud of our skilled, passionate, and empathetic team, confident that you will receive the best care for your needs. To get in touch with our team, request an appointment via our online form today and our Front Office crew will be in contact shortly.

We look forward to helping you return to daily living.