There are instances where an individual might encounter a minor physical problem such as a wear and tear sports injury or perhaps they have a chronic condition that needs periodic physical therapy treatment.  In the past, a patient’s only option consisted of making an appointment with a doctor, who would then (re)evaluate the patient’s condition and then subsequently write out a prescription for physical therapy.  Although there are many times when a patient should first visit their physician for a medical issue, for some it is a costly extra step that does not necessarily have a significant impact on their health status.  In order to streamline the healthcare process, 26 states, including Pennsylvania allow patients to directly access a licensed physical therapist, essentially bypassing the initial visit with a doctor where they would obtain a referral to a PT pain specialist.

The Pros

By allowing patients to have direct access to physical therapy centers, patients avoid spending time and money on an unnecessary doctor visit.  By going directly to a PT pain specialist as in the case of a minor injury, patients can more quickly receive the healing they need, allowing them to get back on their feet as soon as possible.  In the case of chronic health issues, patients can receive the PT treatment they require in a more timely manner, allowing them to reduce their pain and maximize their abilities in a shorter period of time.

Of course just because a patient might want to directly see a physical therapist doesn’t mean their primary care physician is completely outside of the communication loop.  A physical therapist who participates in the direct access program can notify a patient’s primary care physician that they are being seen by a PT and keep the lines of communication open in circumstances where the PT or the physician thinks the patient requires further medical treatment.

State Oversight

In order to ensure that patients are receiving the highest quality medical care, the states offering direct access programs have set up certain conditions which a PT must adhere to in order to offer a direct access program to their patients.  In Pennsylvania, these conditions include:

  • a physical therapist must be licensed in PA by the board of physical therapy to treat patients without a physician’s referral,
  • the PT must publicly display their direct access certificate,
  • the PT must renew their direct access certificate whenever they renew their therapy license,
  • the DA certificate holder may not  treat a patient for any non-neurologic, non-muscular, or non-skeletal condition,
  • the DA certificate holder may not treat a patient who has an acute cardiac or acute pulmonary condition,
  • a direct access PT can treat a patient a maximum of 30 days from the date of the first treatment,
  • and lastly, a direct access PT cannot exceed 30 days of treatment without acquiring a physician’s referral for the patient.

Insurance

As always, a patient should understand what their particular medical insurance provider will cover with regard to any type of physical therapy treatment.  Some insurance providers will cover physical therapy treatments provided through a direct access PT program, whereas others will not.  If you aren’t sure whether your insurance will cover direct access to PT treatments, check with your insurance provider and/or the physical therapist you would like to see.

Summary

Here at Cawley PT and Rehab, we do offer our patients the option of participating in a direct access program.  If you would like to know whether your specific insurance covers these types of PT treatments, you can contact your insurance provider or contact us at 570-208-2787 or email us at: cawleyptfrank@gmail.com.  If you would like more information about Pennsylvania’s state laws that govern direct access PT treatment, please click here.