Physical Therapist, Dr. Amanda Robotti, DPT, explains the basics of New York States’ Direct Access treatment for physical therapy.
What is Direct Access?
Direct access is a law that allows patients to seek treatment from a physical therapist without a referral from a physician, dentist, podiatrist or nurse practitioner. This law varies by state, so it is important to research what is true in your state.
Doctors of Physical Therapy (DPTs) are trained to screen for red flags or serious pathology requiring referral to the appropriate medical professional. On your first visit if the physical therapist is concerned that your symptoms are outside of the scope of physical therapy (PT) or require immediate medical attention, they will educate you and take the appropriate actions to get you the best, timeliest care you need.
What are the New York State laws for direct access?
Since 2006, New York State (NYS) physical therapists have been able to treat patients without a referral for 30 days or 10 visits, whichever comes first. By law, the evaluating physical therapist must have a minimum of 3 years experience and a current NYS Physical Therapy (PT) license.
What does “30 days or 10 visits” mean?
At Physio Logic we provide treatment on the same day as your examination, meaning that your first visit is included in the 10 visit/30 day maximum. To receive PT past 10 visits or 30 calendar days from your initial evaluation, NYS requires that you obtain a referral to continue PT treatment.
To avoid a lapse in care, your physical therapists and care managers at Physio Logic will track this timeline for you. If care after 30 days or 10 visits is medically necessary, you can get a referral from your PCP, own MD or our on-site physiatrist, who is a sports medicine/pain specialist, or our internist who specializes in functional medicine. If your physical therapist assesses that care is not medically necessary beyond 30 days or 10 visits, no MD prescription will be necessary!
Will my insurance cover my PT sessions under direct access?
Most commercial insurances will cover direct access for PT, but it is not guaranteed. Before your first visit, Physio Logic will perform an insurance verification and confirm that you are covered under direct access. If your plan requires a PT referral, that will be clearly communicated to you prior to your initial visit. What is certain, is that at this time patients with Medicare coverage do require a referral for PT.
Why utilize direct access?
Direct access gets you treatment sooner! If you sprained your ankle in a pickup game of soccer, strained your lower back moving a heavy box or just want a tune-up for a chronic knee problem you can come see us right away! You do not have to wait to get an appointment with your doctor which could take weeks, missing out on treatment that can decrease your pain, improve your mobility and get you back doing what you want to do.
Additionally, research is showing utilization of direct access is helping to decrease costs on the healthcare system from unnecessary imaging and/or doctor’s visits for straightforward musculoskeletal injuries.
Check PT direct access laws in your state: https://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Direct_Access/DirectAccessbyState.pdf