We are often asked “do I need a prescription from a Doctor to start Physical Therapy”?
The answer is no, you do not. New York, like many other states, has a direct access law.
The terms of this law differ from state to state, but in New York they are simply this:
A patient can self refer themselves for physical therapy for up to 10 treatments or 30 days whichever comes first. If treatment beyond 10 treatments or 30 days is needed the patient must secure a prescription for physical therapy from a licensed New York State provider (physician, physician assistant, nurse practitioner, or podiatrist) to continue treatment.
The downside or fine print:
Not all insurances will cover physical therapy treatment for patients who self refer. Your insurance policy benefit detail will indicate if a medical necessity order is required for coverage. Most carriers are okay with direct access, some are not, we have a list and/or the staff can help you to determine what your specific plan requirements are.
Most carriers are okay with direct access, some are not. We have a list and/or the staff can help you to determine what your specific plan requirements are.
Often prescriptions are confused with referrals.
A prescription (sometimes called a referral) is from a doctor’s office and it supports their recommendation of physical therapy for your diagnosis.
A referral (sometimes called a pre-authorization) is from an insurance company and could be required by your specific plan to secure optimal coverage from your policy. If a referral is required by your plan and not obtained prior to services your insurance could deny the claim or pay at a reduced rate, either would result in a higher out-of-pocket cost to the patient.