Think you need to get a referral before you see a physical therapist? Read this first!
From time to time, all of us experience physical pain or discomfort that, while bothersome, either seems too minor to be seen and treated by a physician, or needs to be seen and treated sooner than an appointment with a physician can be obtained. In the past, pain treatments in such cases were limited to non-medical options such as over the counter medications or massage therapy. Some simply lived with the pain and adapted to it.
In January of 2014, all of that changed. California passed a new law allowing patients to receive direct physical therapy evaluation and treatment services from licensed physical therapists for a period of up to 45 calendar days or 12 visits (whichever occurs first) – all without the need of a physician referral. The “Direct Access” (or sometimes called “self-referral”) law has proven to be great news for patients for several reasons:
» Many patients want to be evaluated by a physical therapist and don’t want the hassle of going through the referral process which will save patients time and money.
» Physical therapy appointments last 30-60 minutes, so your condition will be thoroughly evaluated and attended to.
» Seeing a physical therapist without the initial physician visit can often result in fewer treatment sessions overall due to more immediate care for injuries. This means earlier return to work and daily activities.
» Physical therapists are highly educated licensed healthcare professionals and in the U.S. more than 96% entry level Physical Therapy degrees are at the doctorate level. So by going directly to a Physical therapist you are being examined, diagnosed and cared for by a licensed, trained expert.There are some limits with Direct Access:
» You should still check with your insurance company to make sure they will cover these appointments without a referral to ensure you follow procedures.
» If a patient on Medicare or Medicaid would like to see a physical therapist without a referral, the patient will need to get written approval from a physician within 30 days of treatment to ensure payment from Medicare. Medicare allows an evaluation without a referral as they recognize that an evaluation must be performed by a physical therapist to determine if it is medically necessary to treat the patient. Once the physical therapist determines care is necessary, a condition of payment for services is documented in a “plan of care” and the patient gets it signed off by their physician.
» If, at any time, the patient shows signs or symptoms of a condition that requires treatment beyond the scope of practice of a physical therapist or the patient is not progressing toward documented treatment goals as demonstrated by objective, measurable, or functional improvement, the physical therapist must refer the patient to their physician. Physical therapists are trained to watch for “red flags” that may signal the need for additional treatment.
» The physical therapist must stop treatment if it extends beyond 45 days or 12 visits (whichever occurs first) unless the physical therapist obtains signed approval of the physical therapist’s plan of care from a physician, osteopathic physician, or podiatrist. The approval must include an in-person patient examination and evaluation of the patient’s condition by the physician or podiatrist. If a patient is seeing a physical therapist simply for injury prevention and is paying for their appointments out of pocket, this stipulation does not apply.
Direct Access even benefits physicians by freeing them up to devote their time to patients who require the skills of a physician versus that of a physical therapist. An appointment with a physical therapist is a safe and smart place to start your road to recovery from a musculoskeletal injury.
We value our relationship with our patients and their physicians and we will always be happy to work with your physician’s office to handle any questions about referrals or point of care services. For questions or to make an appointment please contact Physical Therapy and Wellness Center at 530-529-3636.