Before making an appointment with a specialist, you may believe you need to ask your doctor to refer you. But do you need a referral for physical therapy? 

The short answer is no; you don’t need a referral before pursuing physical therapy.

The longer answer is that you can get physical therapy without a referral, but your insurance may not cover it without one. Without a referral, you may be responsible for the cost of treating your condition depending on state legislation and insurance requirements.

Direct access laws make it possible for patients to pursue treatment on their own. Keep reading to learn more about direct access so you can take control of your health with services like in-home physical therapy.



What Is Direct Access Physical Therapy?

Direct access allows patients to receive physical therapy without a doctor’s referral, giving them more freedom and control over their healthcare. Every state in the U.S. has some form of direct access, though specific laws vary from state to state.

What direct access physical therapy means for patients is more timely treatment, cost-effective care, and improved patient outcomes. “Increased access and utilization of physical therapy through direct access pathways benefit every major stakeholder, including patients, providers, payers, and the healthcare system as a whole,” says Dr. Alex Bendersky, Doctor of Physical Therapy.

One of the most challenging hurdles for physical therapy patients is getting started. The majority of referred patients fail to begin treatment due to:

• Scheduling and accessibility issues
• Financial concerns
• Poor communication from medical professionals
• Low motivation
• Limited understanding of how physical therapy can help them
• Fear of worsening pain or reducing mobility

With direct access laws, you don’t have to go through your primary care physician (PCP) or family doctor to get a referral. The process can be as simple as contacting a physical therapist and showing up to your appointment. With Luna, the process is even simpler: Your physical therapist comes to you, so you don’t even have to leave your house.

Benefits and Limitations of Direct Access Physical Therapy

Direct access allows patients to receive physical therapy without a referral, increasing accessibility and improving recovery. While this practice is extremely beneficial for patients, there are limitations to current direct access laws and practices.

Benefits 

Direct access allows patients to advocate for themselves in pursuit of treatment options that will provide long-term benefits, especially for older individuals. 

“Direct access provides an efficient pathway for older adults to receive preventative physical therapy interventions before mobility, strength, and balance significantly decline,” says Dr. Bendersky.

However, patients of all ages and ability levels can enjoy the following benefits from the direct access model:

• Faster access to skilled care: Without the requirement of a physician referral before treatment, patients can access the care they need without unnecessary delays.
• Improved outcomes: Patients with easier access to physical therapy are more likely to experience better functional outcomes and return to work more quickly. Physical therapy also reduces the risk of recurring or worsening injuries through proactive, holistic treatment.
• Decreased healthcare costs: Reducing physician visits and preliminary imaging services allows for substantial cost savings for patients and insurance providers alike.

Limitations

Patients may not have the information or freedom necessary to take full advantage of direct access. Limitations of current direct access laws include:

• Limited public awareness: Patients often believe that the only path to treatment involves getting a referral from their PCP. Referrals are no longer necessary to start physical therapy, but the lack of public awareness means fewer patients take advantage of direct access pathways.
• Insurance reimbursement requirements: Insurance companies often require a doctor’s referral before they cover specialist visits or treatment plans. The financial burden of healthcare costs is a major deterrent for patients, reducing the positive impact of direct access laws.
• State-specific restrictions: All U.S. states have direct access laws, but only 20 offer unrestricted patient access. State laws may limit direct access physical therapy to certain conditions or impose a cap on the number of visits permitted through direct access, restricting the effectiveness of direct access care.

“These constraints can impede physical therapists from providing the entire continuum of appropriate patient care through direct access models,” says Dr. Bendersky. 

Whether you have a referral or not, part of the challenge of starting treatment is finding the right physical therapist. Luna makes this step easier by connecting you to highly rated physical therapists in your area so you can start treatment as soon as possible.



When Do You Need a Physical Therapy Referral? 

Thanks to direct access legislation, physician referrals are no longer required for patients to receive physical therapy. However, you still have the option to get referrals from your doctor, so you can choose the path that makes the most sense for you.

A referral to physical therapy may be beneficial in the following circumstances:

• You need to meet insurance requirements: Your insurance provider may require a referral before they cover treatment from a specialist. These requirements vary from plan to plan, so you should verify how your insurance covers physical therapy before starting.
• You need a paper trail: Whether you were injured at work or in a car accident, getting a PT referral from your doctor can provide a verifiable paper trail. A referral may be especially valuable if you need to submit an insurance claim or documentation of your treatment following a traumatic event.
• You’re not sure if PT will help: If you don’t know what’s causing your pain or disability, you may not know whether physical therapy is the right approach. Visiting your doctor first can help you rule out possible causes, determine if physical therapy is right for you, and provide a referral to ensure you get the best possible treatment. 

As of 2015, all 50 states, the District of Columbia, and the Virgin Islands have varying levels of direct access. Restrictions and requirements vary, so it’s best to identify the specifics of where you live before pursuing treatment.

Whether you get a physician referral or self-refer, you can easily schedule in-home physical therapy with Luna. 

Physicians often refer patients to Luna because they can get faster access to on-demand care and spend more time with qualified PTs wherever they are.

How To Get Physical Therapy Without a Referral

If you’re considering physical therapy but don’t know where to start, you may be asking, “Do you need a referral for physical therapy?”

The answer is no, you don’t need a referral! Direct access laws allow patients to receive physical therapy without a referral, making it easier to get essential treatment.

Dr. Bendersky says, “Full utilization of direct access by clinicians will enable them to retain agency over clinical decision-making and care pathways, optimizing patient outcomes while reducing downstream healthcare costs.”

Whether you have a referral or choose to refer yourself, Luna can connect you with a highly skilled physical therapist in your area. Start your recovery journey with Luna today.

FAQ

Should You See a Doctor or Physical Therapist First?

It depends. Physical therapists undergo extensive schooling, training, and continuing education to get and maintain their licenses. A physical therapist can evaluate your condition and determine the best course of action, whether through physical therapy or another specialist. 

If your physical therapist believes different treatments will be more effective or a medical diagnosis is necessary, they can refer you to the appropriate specialist.

If you need serious, immediate medical attention, contact emergency services or your doctor first.

Do You Need a Prescription To Go to Physical Therapy?

No, you do not need a prescription for physical therapy. Physical therapy referrals and prescriptions are similar but distinct. 

A referral is an authorization from your doctor indicating that you are eligible for treatment. A prescription is a written order for treatment, often with specific instructions from your doctor. You may get a physical therapy prescription after an injury to ensure your recovery goes as smoothly as possible.

Can You Self-Refer to Physical Therapy?

Yes, you can refer yourself to a physical therapist. Thanks to direct access laws, you can schedule physical therapy without requesting a referral from your doctor. Even if you self-refer to physical therapy, your physical therapist will update your medical team about your progress. 

Can a Chiropractor Refer You to Physical Therapy?

Yes, a chiropractor can refer you to physical therapy. While you can get a referral from a chiropractor, direct access allows you to pursue physical therapy on your own.

Physical therapy focuses on strengthening your muscles and teaching your body how to move correctly. This treatment can help you get relief and prevent future symptoms, while chiropractic care may only provide short-term relief without additional treatment.

Chiropractors cannot prescribe medications or other treatments but can provide referrals to other medical professionals. If you see a chiropractor and haven’t found relief from your symptoms, physical therapy may be your next step.

Will Insurance Cover Physical Therapy Without a Referral?

Yes, most insurance providers will cover physical therapy without a referral, thanks to direct access laws. However, your coverage may vary depending on state-specific limitations and insurance requirements. You will usually be responsible for co-pays, deductibles, and co-insurance costs as specified in your insurance plan. We recommend verifying your insurance coverage before receiving care to avoid unexpected costs.

Luna contracts with several insurance providers but may be considered out-of-network for some PPO patients. When you schedule physical therapy through Luna, our team will review your insurance coverage, verify your benefits, and accurately estimate how much you’ll pay per session to help you avoid financial surprises.