Direct Access

Q & A

Q: What is consumer direct access to Physical Therapy?
A: Due to recent legislative changes, Californians may now see their physical therapist without first seeing a medical doctor; no referral or medical diagnosis is needed

Q: How do patients benefit from Direct Access to Physical Therapy?
A: Being able to go directly to a Physical Therapist negates delays in treatment and unnecessary co-pays paid to a physician simply for referral to a physical therapist.

Q: Will Insurance pay for direct access physical therapy?
A: Currently, Medicare beneficiaries are covered under direct access care. As the law was just recently adopted, it will take time for commercial health plans (Blue Shield, Anthem Blue Cross, Cigna, etc..) to amend their internal policies to allow for payment without a physician referral. Many have already expressed a willingness to do so and, in fact, already do in States which have had direct access for many years. If you are not sure whether your insurance carrier covers direct access physical therapy, simply call our office, provide us a little information and we will call and verify your benefits for you.

Q: Are there limitations to the Direct Access provision?
A: Current law states that a patient can be seen for 12 visits and/or 45 days without seeing a medical doctor. If treatment is needed beyond these limits, the patient must see a medical doctor prior to physical therapy continuing. This provision holds the physical therapist accountable for making progress and assuring collaboration of multi-disciplinary providers in more complicated cases.

Q: What about chronic pain and degenerative musculoskeletal conditions which often require ongoing or prolonged care; beyond the 45 day provision?
A: The 12 visit/45 day limitation “only” applied to patients without a medical diagnosis. For instance, if you have been previously diagnosed with spinal stenosis (a degenerative condition which is “managed” but not “cured”) and have something in writing to document that diagnosis, physical therapy treatment would not be limited.