Direct Access

Do you need to see a physician before coming to physical therapy?

The answer is simply – No. Since 2003, New Jersey consumers have had the ability to access the services of a physical therapist directly without a referral from a physician, but very few understand the benefits of this strategy and when they should consider it. Quite simply, there are many non-traumatic events in a person’s life that require medical intervention and often they make choices that waste their healthcare spending on unnecessary physician visits, expensive tests and drugs without actually getting any treatment to fix the problem.

“Getting your pain or injury assessed by a physical therapist, offers the consumer an opportunity to be educated about the problem, get immediate treatment, learn what it will take to get better faster and reduce the chance for re-injury” said David Bertone, PT, DPT, OCS. Of course, there will be times when a medical diagnosis is required, so a referral will then be made to the appropriate physician.

Common problems that would benefit from an evaluation and treatment by a physical therapist would be waking up with a stiff neck, low back pain, ankle sprains, shoulder pain with limited mobility, muscle strains, knee pain and many other conditions that are limiting your ability to function at home, work or in your recreational sport.

A recent publication by the Centers for Disease Control (CDC) also emphasized the benefits of physical therapy for the treatment of chronic pain instead of opioid medications which can be highly addictive. They also concluded that there is evidence that exercise supervised by a physical therapist can reduce the pain associated with knee and hip osteoarthritis and be able the sustain the reduced pain state for 2-6months. These findings are supported by strong clinical evidence and patients can access the skills of a physical therapist directly here in New Jersey, thus saving valuable healthcare dollars.

Can a Physical Therapist diagnose my problem?

While physical therapists do not make a medical diagnosis, the diagnosis of your functional impairment is within our scope of practice and can be vitally important in determining the cause of you pain that may be affecting your ability to participate in functional and recreational tasks. The diagnosis is a label for a collection of signs and symptoms gathered through the evaluation and examination of your particular problem. It is an essential part in determining the course of treatment and the predicted time frame it will take to complete the goals established.

Medicare and Direct Access – Can you come directly to physical therapy?

If you are a senior citizen and covered by Medicare Part B you can come directly to physical therapy without a referral from your physician. However, you must be under the care of a physician and they must agree and sign the plan of care established by the physical therapist. For example, you may develop acute neck pain and would like to see us for immediate treatment. We can perform an evaluation and initiate treatment, but your physician of record must sign and agree to the plan established which is faxed to their office. Some physicians may want to see you before agreeing to this plan but most will sign and certify the plan directly.

Are there any exceptions to my insurance company paying for Direct Access to physical therapy without a referral?

Yes, there are a few instances that still require a referral from a physician in order for your insurance company to pay for services. This may include if your injury is due to a Motor Vehicle Accident or your particular insurance plan requires a referral to see any specialist. In both cases a referral and not a prescription is required. We will always tell you in advance if any of these conditions exist that may affect payment for physical therapy services.

Can a physical therapist order an X-ray, MRI or other special tests?

Yes, this can be done to help clarify your physical therapy diagnosis is correct and to help determine a need for you to be referred to a physician or specialist for a consultation.

Here is the NJ Law that governs the practice of Direct Access to Physical Therapy Services:

13:39A-2.5 REFERRAL OF PATIENTS AND CONSULTATION STANDARDS FOR LICENSED PHYSICAL THERAPISTS a) A licensed physical therapist shall refer a patient to a health care professional licensed to practice dentistry, podiatry or medicine and surgery in this State, or other appropriate licensed health care professional: 1) When the licensed physical therapist during the examination, evaluation or intervention has reason to believe that physical therapy is contraindicated or symptoms or conditions are present that require services outside the scope of practice of the licensed physical therapist; or 2) When the patient has failed to demonstrate reasonable progress within 30 days of the date of the initial treatment. b) Not more than 30 days from the date of initial treatment of functional limitation or pain, a licensed physical therapist shall inform the patient’s licensed health care professional of record regarding the patient’s plan of care. In the event there is no identified licensed health care professional of record, the licensed physical therapist shall recommend that the patient consult with a licensed health care professional of the patient’s choice. In a school setting, the schedule of physical therapy services shall be reported to the child study team by the licensed physical therapist within 30 days of the date of initial treatment.