Do I Need a Referral for Physical Therapy?
by JayDee Vykoukal, PT, DPT
If you're experiencing bone, muscle, or joint pain, you may be wondering if you need a referral from your doctor in order to see a physical therapist. The simple answer is no!
Typically, no doctor referral is needed for a physical therapy visit. This is thanks to legislation called "Direct Access" that allows patients to skip their doctor and go to see a physical therapist first.
In this blog post, we'll take a look at what direct access is and and why removing the middleman from the equation can help you recover quicker.
Table of Contents
- What is a Referral?
- What is Direct Access?
- Are There Any Restrictions to Direct Access?
- Can Insurance Limit Direct Access?
- Do I Need Insurance to Afford Physical Therapy?
- Isn't It Better to See My Physician First?
- The Benefits of Direct Access
- When Should I See a Physical Therapist?
What is a Referral?
A referral is defined as a healthcare professional's recommendation that you see another medical specialist for your condition. Typically, a primary care physician (PCP) or specialist will give you a script that you take to the chosen provider.
While some physicians will provide specific recommendations, a referral can usually be taken to any clinic within the designated specialty. It's important to note that some physicians have their own internal physical therapy clinics, which can create a conflict of interest. Thus, recommendations are not always based on the highest quality clinic that is a good fit for your needs.
What is Direct Access?
Direct access is defined as the ability of a patient to go directly to a physical therapist for care instead of going to their doctor first. So, you don't need a doctor's order to see a physical therapist.
The American Physical Therapy Association (APTA) supports direct access because they believe that it contributes to earlier intervention, fewer health care costs, and improved patient outcomes.1
Currently, all 50 states, D.C., the Virgin Islands, and the District of Columbia allow some form of direct access to physical therapy.
Are There Any Restrictions to Direct Access?
There are variations in the laws from state to state. For example, some states have restrictions on the number of visits you can have without a referral while other states have no restrictions at all.
For example, Arizona has no restrictions on the number of visits while Indiana requires a doctor's order if further treatment is needed after 42 calendar days. Unfortunately, many of these restrictions are arbitrary and are being continuously rebutted as physical therapists strive to change limiting legislation.
For more info on direct access by state, click here.
Can Insurance Limit Direct Access?
Most insurance companies, such as Blue Cross and Cigna, provide coverage for direct access to physical therapy. However, policies are always changing so it's best to check with your insurance company first. If you're unsure, your physical therapist's office can typically help you determine what is needed for adequate coverage.
One special circumstance to note is Medicare. While you don't need a referral, your primary care physician (PCP) will need to sign off on the plan of care your physical therapist creates after your initial evaluation. That means that you can still go directly to a physical therapist with Medicare.
Do I Need Insurance to Afford Physical Therapy?
If your insurance company doesn't provide the coverage you need, or if you have a high deductible plan, you should consider finding a private pay physical therapy practice that provides high-quality care. When you factor in the total cost of care using insurance, you'll find that paying cash provides a lot of benefits and is surprisingly affordable.
You can read more about the benefits of cash pay physical therapy here.
Isn't It Better to See My Physician First?
Generally speaking, no. Primary care physicians are generalists, and may not have the in-depth knowledge that a physical therapist has about your bones, muscles, joints and ligaments.
Many physicians don't refer their patients to physical therapy for pain management. This is in spite of the fact that physical therapy treatment is best for reducing opioid dependence, risk of surgery, and boosting overall quality of life. We did our own research on how gatekeepers sometimes create barriers to pain management. Check it out for more information.
Thus, physical therapists can provide their own type of primary care, but for bones, muscles, and joints. Physical therapists are trained to do extensive screenings and can refer you to a physician at any time if they have any concerns. This makes going directly to a physical therapist a safe and cost-effective way to optimize your recovery.
The Benefits of Direct Access
There are many reasons that direct access is in everyone's best interest. According to a 2018 systematic review,2 here are just a few of the top benefits:
- Lower overall healthcare costs due to a reduced need for physician visits, physical therapy visits, and imaging
- Reduced dependence on pain medications and secondary care (surgery, follow-up care, etc.)
- Overall patient satisfaction is higher
The reason for all these benefits is relatively simple. A CityPT physical therapist will spend significantly more time with you than a physician would (an average of 45 minutes with a physical therapist). Plus, they will ask extensive questions that help them get a better feel for your lifestyle to help you recover holistically.
When Should I See a Physical Therapist?
There are many reasons to seek out physical therapy. Maybe you're dealing with pain, want to prevent surgery, or are recovering from an injury. The sooner you seek help the quicker you will be on the road to recovery. No matter the reason, a physical therapist can help you reach your goals holistically and get you back to your best self.
Plus, with options like our virtual physical therapy, you can book an appointment today and be on the road to recovery. We look forward to helping you reach your goals and live life to its fullest!
Before you go, please read our disclaimer. This blog is intended for informational purposes only. We are not providing legal or medical advice and this blog does not create a provider-patient relationship. Do not rely on our blog (or any blog) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
APTA. Direct Access Advocacy. APTA.org. Accessed August 25, 2022. https://www.apta.org/advocacy/issues/direct-access-advocacy ↩
Piscitelli, D; Furmanek, M.P; Meroni, R; Caro, W; Pellicciari, L. Direct access in physical therapy: A systematic review. La Clinica Terapeutica. Published September 10, 2018. Vol. 169 No. 5 (2018) ↩