RESOURCE BLOG
Empowering Health-Conscious Adults Through Public Education And Local Pro-Bono Efforts
Do I Need A Referral To Be Seen For Physical Therapy?
Written by Dr. Gabriel Trincado, PT, ACSM-EP
Physical therapists (PTs) require doctorate-level education with countless hours of clinical experience prior to graduation in addition to an undergraduate degree. PTs evaluate and treat impairments of the musculoskeletal system, vestibular system, and nervous system which impair functional abilities and quality of life. They also diagnose such functional impairments (not medical diagnoses), create plans of care, and refer for further medical management if deemed appropriate.
Normally, with many services you may need a physician referral, such as with labs or imaging, specialist visits (orthopedists, neurologists, physical or occupational therapists), and other services. Let’s say you are dealing with back pain, shoulder pain, or need help with creating a comprehensive wellness plan, and you want to see a trustworthy physical therapist to assess your needs and create an individualized plan for you.
Questions you may have include: how do I go about seeing a PT? Do I need to see my primary care provider (PCP) first to get a referral, or can I be seen without one?
Thankfully, we have direct access laws which allow you to be seen by a physical therapist directly without need for a physician referral! Every state has direct access with different rules about how this works, and what specifically is allowed. The rules differ as to what interventions can be utilized, what number of visits or days prior to needing a follow up with your physician and a referral for continued care, and other factors.
Well, if you live in North Carolina, there is good news for you! Here in NC we are fortunate to have pretty unrestricted direct access (DA) laws. As per the physical therapy practice act of the state of North Carolina, no referral is needed in order to be seen by a physical therapist so long as there is no manipulation of the spine (think of the maneuvers that create an audible pop like you see in chiropractic adjustments). Additionally, anyone can be seen by a PT without a referral as long as the patient's condition is within the scope of practice of PT as deemed at the evaluation or at any other treatment visit. An example of a client being outside of the scope of practice for PT would be if a medical emergency were taking place such as signs of an acute stroke, in which case they would immediately be sent to the ER to receive necessary imaging. PT's are trained to assess for these emergency situations. In addition, while the use or need of manipulation makes you ineligible to be seen through DA, acquiring a referral would allow the PT to utilize those types of interventions so long as they are sufficiently trained and experienced.
Seeing a PT via DA sounds pretty easy now, doesn’t it? However, depending on your insurance, you may have more to consider. If you have a deductible, you will likely need to meet it prior to seeing any payment from the insurance company, or you might receive a minor discount. If you don’t have a deductible you may still have a copayment due at each visit. Many insurance companies do recognize state’s DA laws, however some still require an order or pre-authorization prior to being willing to pay for any services at all. If you want to know if your visits would be covered by insurance, you will want to call your insurance company directly to find out if they require anything before being seen and find out if a clinic is “within the network” for the insurance company (ie. they take your insurance). If you’re paying out of pocket for your services, you have unrestricted access to physical therapy services, within the limits of your state’s DA laws.
Here at Triangle Concierge Physiotherapy, we work largely through direct access, but also welcome referrals if you have them! If you’re not sure what physical therapy can do for you, have further questions regarding direct access, or you have any questions like what a session might look like, feel free to reach out to us through our contact page!
