Do I need a referral for PT?

Author: Brooke Carmen, PT, DPT: Doctor of Physical Therapy and Blog Contributor.  Loves fun informational gems.  Fitness addict and wannabe foodie. Emphasizes patient-specific treatment style and promotes goal-oriented care. Learn more about Brooke on here.

Direct access is the term that refers to the ability of a client to go into physical therapy without a provider’s referral.  All states, the District of Columbia, and the US Virgin Islands allow direct access, but each state has specific guidelines and different restrictions on direct access.

Can I use direct access?

Most of the time in Oregon, the answer is yes. However, the answer primarily depends on your insurance.  Medicare and Medicaid insurances all require referrals.  Other insurances like United Health Care, Cigna, HealthNet, Moda and BCBS in most cases all allow therapist to be seen without a physician's referral.  To find out if your insurance allows physical therapy without a referral, contact the company with the number on your card.  Anyone can come to physical therapy without a referral if they pay out of pocket.

What is the benefit of direct access for me?

Direct access is one step less for you and saves money.  For example, if you have knee pain and schedule an appointment with your primary care, they will likely refer you to physical therapy if your condition is musculoskeletal (the majority of the time it is).  This step takes time and in most cases, involves a co-pay.  If you go to physical therapy first, we can send what we find to your doctor to update them without you visiting prior to coming here.  We also rule in and out non-musculoskeletal conditions, so we let you know when you need to go to your doctor.

What does “musculoskeletal” mean?

Anything that refers to bones, muscles, tendons, ligaments, bursae, etc. in the body.  Musculoskeletal main can be acute (short lived) or chronic (longer lived).  It can present in a variety of different sensations including dull, burning, aching, sharp, shooting, etc.

What if my condition is non-musculoskeletal, and I didn’t go to my doctor?  Isn’t that then a waste of time coming to physical therapy first?

If you come in to see a physical therapist with a non-musculoskeletal condition, they won’t continue seeing you.  We refer you out.  Coming to us first with something that you suspect is musculoskeletal, but isn’t, is rare, but it can happen.  Physical therapy degrees have shifted from a master's to doctorate program for this reason.  We are trained to know when a condition is not appropriate for us to treat.  If we don’t pick up on it, it’s malpractice.

Shouldn’t I get imaging before coming into PT?  So we know exactly what is going on?

This question comes up a lot and the answer in most cases is no.  This is also something that we would refer you for.  In Wisconsin now, we can order them for you.  You don’t want to pay for imaging and be exposed to radiation or go through an MRI if you really don’t need to.  Imaging does not correlate with pain in some cases.  Now, if you sprain your ankle and you can’t walk on it, it’s black and blue, and swollen, going to an urgent care or the hospital and get an x-ray would be a good idea.  If you have something like chronic neck pain with no history of trauma to the neck, come to us.

If you have more questions about direct access, musculoskeletal conditions, PT training, or imaging, please feel free to contact me via email.  If you are unsure if your insurance allows direct access or if you have questions about cash pay rates, contact our front desk at our clinic's phone number.