Do You Need a Referral to See a Physical Therapist?

In the state of California patients have the right to direct access of physical therapy services. What does it mean to have “direct access”? Well, the definition varies from state to state. In the state of California, it means that a physical therapist can evaluate and treat a patient for up to 45 days or 12 visits, whichever comes first, without a referral from their medical doctor. 

However, it is important to note that many insurance carries require an MD’s referral and/or an authorization from the insurance company for them to reimburse for services.  So before heading into your local PT clinic (Performance Plus PT) it is always best to give your insurance provider a call and ask, “Do I need a referral or authorization to see a physical therapist?”. If the answer is no, then head on in to see your local PT! 

If you do not have health insurance or your health insurance company isn’t in network with the physical therapy clinic that you want to visit, you have the right to direct access! It is as simple as calling in and making an appointment for your initial evaluation. 

Sometimes patients are concerned that they may need diagnostic imaging such as an MRI prior to making a PT appointment. This is simply not the case. A physical therapist is educated in developing a differential diagnosis and treatment plan based on your symptom presentation and various objective tests and measures. Through this process, physical therapists are also able to determine if your appropriate for PT or if a visit to your primary care MD is needed instead.

So, the next time you have a pain, ache, difficulty with a functional part of your life, or just want to be preventative, practice your right to direct access and head on into Performance Plus PT! 

By Tiffany Sheffield, PT, DPT, MHA