Posted February 3rd, 2014 at 3:18 pm
Patients can directly access physical therapy services without first getting a physician diagnosis or referral…
What is consumer direct access?
Consumer direct access is about improved consumer choice. As of January 1, 2014, patients can directly access physical therapy services without first getting a physician diagnosis or referral. This applies to cash patients and a few insurance companies. Many insurance companies still require a physician referral to reimburse physical therapy treatments. Please confirm your benefit requirements by reviewing your coverage documents or calling member services of your respective insurance company. The contact number to your insurance company is listed on the back of your health insurance identification card.
Are there any restrictions to directly accessing physical therapist services?
Yes. Individuals can directly access physical therapist services and receive treatment for up to 45 calendar days or 12 visits, whichever comes first. However, according to treatment data, 90 percent of patients will not require services beyond 45 days/12 visits.
What happens after the 45-day/12-visit limit?
If you require additional services beyond the 45 days or 12 visits, whichever comes first, you will need to be referred to your physician for an exam and signed Plan of Care (POC). If you don’t have a physician, your physical therapist may refer you to a physician. If you have a diagnosis from a physician prior to the 45-day/12-visit deadline, you would be allowed visits beyond the time limits.
If a patient has a previous medical diagnosis, does that fall under the 45-day/12-visit limit?
No. A patient with a medical diagnosis is not subject to the 45-day/12-visit limit. The limits only apply to patients directly seeking physical therapist services without a diagnosis.