Are You Aware of Your State’s Direct Access Laws?

Physical Therapy is more accessible than you may think.

No referral? No problem.

When you suffer an injury or are experiencing pain, having direct access to the treatment you need – when you need it – means faster diagnoses, prompt care, and quicker healing.

In the past, insurance companies required patients to obtain a physician’s referral or prescription before seeking physical therapy treatment. This policy meant additional appointments, costs, commuting, and delays in patient care. Unfortunately, the delays in treatment that patients experienced often result in surgeries that could have been avoided, permanent injuries, and the prolonged use of opiates for pain management.

Throughout the early 1990s and 2000s, Physical Therapists sought change by fighting for legislation that would secure patient access to physical therapy services. sadly, these efforts were widely opposed by physicians and other clinicians. But by 2015 the fight saw nation-wide victory with all states implementing some level of direct access to Physical Therapy. These efforts continue in 2022, with legislation continuing to be introduced that would expand services offered by Physical Therapists.

Under Direct Access Laws patients may seek physical therapy treatment from a licensed Physical Therapist without a physician’s referral or prescription. Physical therapists may perform evaluations, determine a treatment plan, and in many cases, begin treatment while patients await their physician appointment.

If a therapist recognizes symptoms that fall out of the scope of physical therapy, they can refer patients to a physician or appropriate specialist. Direct Access gives patients the chance to advocate for their own healthcare, and physical therapists the chance to advocate their practice expertise.

Direct Access laws are determined on a state level and can be divided into three categories: Restricted, Provisioned, and Unlimited, with each state fitting into one of these categories.

  • Unrestricted Direct Access where patients can be evaluated and treated by a licensed physical therapist without physician’s referral or monitoring.
  • Provisioned Direct Access allows therapists to perform evaluations, and begin treatments, but provisions may restrict the number of visits and types of treatments available. Additional regulations may apply from state to state.
  • Restricted Direct Access allows therapists to perform initial evaluations on patients, but a physician’s approval is required before treatment may start. Restrictions are high and additional regulations may apply from state to state.

Figure 1: Direct Access to Physical Therapy by state. Image created by Systems4PT

Like a lot of things ‘healthcare’, Direct Access can be complicated. Fortunately, we’ve compiled a list of trusted resources to help you get to know the Direct Access available in your community. Remember, Systems4PT only uses trusted information from reputable & peer-reviewed sources. We supply this information and access to sources for your convenience.

Hover and click a link below to read more information.

  1. Direct Access State By StateFederation of State Boards of Physical Therapy. (2014, August). Jurisdiction Licensure Reference Guide Topic: Direct Access Laws and Regulations. Fsbpt.Org. Retrieved June 2022
  2. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid useKazis LE, Ameli O, Rothendler J, et alObservational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use.
  3. A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical TherapyPendergast, J., Kliethermes, S.A., Freburger, J.K. and Duffy, P.A. (2012), A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy.
  4. Legislation Allowing for Improved Access to Physical Therapy and Further Providing for Dry Needling as Acceptable Practice for Physical Therapy in PennsylvaniaPennsylvania General Assembly. Bill Information – senate Bill 485; Regular Session 2021-2022. The official website for the Pennsylvania General Assembly. Retrieved June 29, 2022

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