Do You Need an MD Referral for Physical Therapy?

physical therapy session

This is a question we get asked a lot around here, at Back & Body Medical, so I thought it was worth laying out the rules of the road in a blog post.

We’re lucky to be in New York state.  You don’t need a referral from your primary caregiver to proceed with physical therapy, because New York is a direct access state.  That said, there are some guidelines concerning accessing physical therapy you should know about.

The basics.

Because of the increasingly favorable profile of physical therapists, legislation has made it possible for people to proceed with a course of physical therapy without first being referred by an MD.

New York patients may visit a chiropractor 10 times, or for 30 days (whichever comes first), via the provisions of direct access.  After the 10 visits or 30 days have elapsed, patients must seek a referral.

All that said, certain people are not eligible.

Those on Medicare, Workers’ Compensation, or No-Fault coverage are required to obtain a prescription for these services.  But even those who are eligible may come up against insurer requirements.

Eligible people under insurance plans which required a referral are usually expected to obtain this, not from the physician involved directly, but from his staff.  That means you can usually call your doctor’s receptionist to satisfy your insurer’s requirements.

Other considerations.

Physical therapists eligible under direct access must have 3 years’ experience practicing full-time, be over the age of 21 and have a current NYS PT license.

While most insurers cover the cost of physical therapy, you should make sure this is the case beforehand.  Of course, we double check your insurer’s conditions on your PT’s end, too, to avoid any future misunderstandings.

Even eligible people will be provided with written notification by their physical therapist that direct access visits may not be covered by their insurer.  They must also formally advise you that if you seek a referral, you may be covered.  This information is kept on file to ensure that patients know that their PT has done due diligence in the matter.

Why direct access is helping.

Direct access is removing healthcare bottlenecks formerly occasioned by the MD referral system.  By giving patients the ability to seek care directly, with no intermediary, they’re able to source support more quickly.

Direct access is also mitigating some of the strain on the healthcare system.  By allowing patients an earlier intervention than they’d have under the referral system, the need for unnecessary imaging to determine whether a referral is required is eliminated.

Chiropractors and physical therapists.

At Back & Body Medical, we practice exceptional, integrated care, drawing on the disciplines of chiropractic, physical therapy, sports medicine and acupuncture.

If you’re coming to us under direct access legislation, we’ll ensure that you receive treatment as quickly as possible, to remain within direct access’s guidelines concerning timing.

So, do you need an MD referral for physical therapy?  We hope this post has answered the question.  Contact us, if you’re seeking superior physical therapy services.

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