With Direct Access (also known as Self Referral), you can get the care you need right away, without the unnecessary delay of waiting for a doctor’s appointment and referral. As of July 1, 2015, if you have a problem that may benefit from the skilled services of a physical therapist, you may come in for an evaluation and up to 60 days of treatment without a referral from a physician or other health care practitioner. If you need care beyond the 60-day time limit, your physical therapist may contact your identified provider to obtain authorization to provide additional therapy services until you can be seen by your provider.
What is Direct Access?
Direct access means that the physician referral mandated by state law to access a physical therapist for evaluation and treatment has been lifted. Delays in care result in higher costs, decreased functional outcomes, and frustration to patients seeking physical therapy treatment. Eliminating the referral requirement makes health care more accessible to more people, which results in timely, more effective care.
Benefits of Direct Access
Some of the benefits of Direct Access include:
- Direct access eliminates the delay in treatment caused by waiting to see a physician for a prescription for physical therapy.
- Our doctors of physical therapy are trained to evaluate and treat and refer to an appropriate medical professional for issues outside of our scope of practice.
- Direct Access puts you in charge of your care and you get to choose the provider you like best.
- Most insurance companies cover direct access.
- Even if you require a referral, you have the right to choose your own physical therapist. You are not obligated to receive physical therapy in any specific facility, even if your physician refers you for physical therapy in the physician’s office or to a facility where the physician has a financial interest.
Are there any restrictions or limitations for Direct Access in Virginia?
The following are some limitations to direct access in Virginia:
- A PT cannot perform an initial evaluation of the patient if the PT has performed an initial evaluation of the patient for the same condition within the past 60 days.
- A physical therapist who has not obtained a doctorate of physical therapy or certificate of authorization according to Section 54.1-3482.1 can conduct a one-time evaluation of a patient. However, the therapist cannot provide treatment without a referral. The PT must immediately refer the patient to an appropriate provider if necessary.
Although direct access to physical therapy care is now allowed by law, some insurance carriers continue to require a physician's referral before they will cover physical therapy services. Federal or state-funded programs, such as Medicaid, Medicare or Tricare, always require a referral for physical therapy, but you can still choose to receive your treatment at Physical Therapy Center of Chesapeake. Please call our office today, and we will let you know whether your insurance covers direct access.