In New York and New Jersey, patients are able to be evaluated and treated by a licensed physical therapist without a physician’s referral, called Direct Access. Some insurance plans may still require you to consult with a physician first, in order to be reimbursed for services, so please check with your insurance provider as plans differ.
Direct access benefits patients in that it allows patients to expedite treatment, saving time and money.
More information is available on the American Physical Therapy Association’s website: www.apta.org
New York Direct Access Provisions
- Treatment can be rendered by a Licensed PT for 10 visits or 30 days, which ever comes first.
- PT must have practiced PT on a full-time basis for at least 3 years and be 21 years old.
- PT must provide written notification that services without a referral might not be covered by the patient’s health plan and state that services might be covered by health plan with a referral. A copy of the written notification must be in the patient’s file.
New Jersey Direct Access Provisions
The physical therapist shall refer patient to a health care professional licensed in New Jersey for the following reasons:
- If the PT has reason to believe that services outside of physical therapy are needed,
- Patient has failed to show reasonable progress within 30 days of initial treatment
At 30 days from initial evaluation, the PT shall inform the patient’s licensed health care provider regarding the patient’s plan of care. If one does not exist, the PT shall recommend the patient consult with a licensed health care provider.
How does Recovery Physical Therapy handle Direct Access?
- Prior to your first appointment, we will encourage you to check with your insurance provider about reimbursement policies.
- At your initial evaluation, in accordance with State regulations, we will have you sign the written notification regarding reimbursement.
- At any time during evaluation and treatment, if we feel your condition is more involved or we are not seeing progress, we will refer you to an appropriate specialist.
- After 10 visits or 30 days (in NY), if further visits are needed, we will refer you to your health care provider for a physical therapy prescription.
What does this mean to me?
By law, you are no longer required to obtain a physician’s referral prior to being treated by a PT. This means that you can be evaluated and treated by a licensed physical therapist immediately, which results in better outcomes and reduced costs.
How do I know my PT is qualified to diagnose and treat my condition?
Physical therapists are licensed health professionals who are educated at accredited physical therapy programs at approved universities. They are qualified to examine, evaluate, diagnose, treat and rehabilitate patients with functional limitations, impairments or disabilities. Physical therapists receive extensive education and clinical training and continuing education.
Health Providers Service Organization (HPSO), the leading liability insurer of physical therapists in the United States, states in a March 22, 2001 letter, “that direct access is not a risk factor that we specifically screen for in our program because it has not negatively impacted our claims experience in any way. In addition, we do not have a premium differential for physical therapists in direct access states.”