What Exactly Is Direct Access?
- Written by Ann Dennison Ann Dennison
- Published: 10 October 2012 10 October 2012
By Kateri Kane, PT, DPT
October is Physical Therapy Month, so we thought we would use this opportunity to provide some good information you might not know about the field of physical therapy. Have you ever heard the terminology direct access in relation to physical therapy? If not, here’s the run down. Direct access is an individual’s freedom to acquire physical therapy treatment WITHOUT a referral from a physician. Say for example, you twisted your ankle or started having back pain and needed physical therapy to recover. Through direct access you are able to bypass going to a doctor’s appointment in order to get a referral for PT.
Direct access not only saves you the hassle of visiting your doctor, it can also save you money. According to a study by Jean M. Mitchell and Gregory de Lissovoy, when comparing physician referral episodes of physical therapy. Direct Access episodes, total paid claims were 2.2 times higher for physician referral episodes. Direct access episodes also encompassed fewer visits and thus less cost in this study. Even though your insurance may cover the majority of your physician and PT visit costs, you still have to pay your copay every visit. These costs can add up, especially as the rates of copays increase; so the idea that you MAY have fewer PT visits and no doctor visit to pay for could be financially helpful.
Unfortunately, not EVERY state has direct access, but the majority of states do. According to the APTA, 47 states and the District of Columbia have direct access. Michigan, Indiana, and Oklahoma are the only states that DO NOT. Michigan and Oklahoma allow for a PT evaluation but no treatment without a referral, while Indiana does not allow for either of these without a referral. Despite the fact that a majority of states have direct access, each state has different rules and possible restrictions that can be viewed here.
So how exactly does direct access work? In Pennsylvania, you are permitted to see a physical therapist that has a Direct Access certification for up to 30 days without a prescription from a physician. If you require treatment for longer than this amount of time, then your physician will need to be contacted and sign off on a plan of care to continue with treatment. If a therapist determines that you need further testing or that you are not an appropriate candidate for PT at the time of evaluation, he/she will refer you to your physician or a specialist.
Even though state law may allow you to see a PT through direct access, your insurance may not pay for it. Medicare in particular allows for an initial evaluation through direct access, but will not cover any treatment without a referral from a physician. It is important for you to be familiar with your insurance plan in order to know what is covered. If you are unsure of your plan benefits, you may want to ask the physical therapist’s office to check into your coverage before you begin therapy.
We hope this information helps give you a better idea of what PT benefits are out there for you. Once again if you have any comments, questions, or suggestions for future topics let us know. Thank you and stay active.