Frequently Asked Questions
Answers to common questions about referrals, prescriptions and insurance.
Can I use a referral from a provider who isn’t licensed in New York?
In general, no. Physicians, dentists, podiatrists and nurse practitioners who are not licensed in New York may not practice here, so they cannot write prescriptions or referrals for physical therapy performed in New York by a New York-licensed physical therapist.
There is one exemption: a physician who is licensed in a bordering state and lives near the New York border. This is generally interpreted as living within 25 miles of the border. A physical therapist may accept a referral from such a physician. The exemption applies only to physicians, not to other providers.
What is the difference between a referral, a prescription and an authorization?
Often called a referral
A written order from a licensed practitioner (physician, nurse practitioner, podiatrist, dentist or midwife) with instructions for your physical therapy. A complete prescription typically includes:
- the date
- your diagnosis
- how often you should be treated
- for how long — for example, twice a week for 8 weeks
In practice, a prescription covers the visits and time period it states. Once your visits are used up, or the time has passed, it needs to be renewed to continue treatment — so it is best to use it promptly.
Comes from your insurance company
Your insurer issues an authorization to decide in advance how much physical therapy it will pay for. It often requires a prescription and written reports from your therapist.
Keep in mind that having a certain number of physical therapy visits in your yearly benefits does not mean your insurer will authorize — and therefore pay for — all of them.
Many insurance plans, in or out of network, require a prescription in order to reimburse you for treatment — even though New York allows direct access. Check with your plan before you begin.
Do you take my insurance?
We are not in-network with any commercial insurance plan. You pay at each visit — $300 for an initial evaluation and $150 (30 min) or $225 (45 min) for follow-up visits — and we give you a superbill you can submit to your plan for out-of-network reimbursement. HSA and FSA cards work too.
For Medicare, we are a non-participating provider and submit your claims directly to Medicare. You, or your secondary insurance, cover the 20% Medicare doesn’t pay, along with any deductible.
We do this on purpose. It lets every visit be one-on-one with the same physical therapist — no aides, no hand-offs — and lets your care follow what you need, not a visit limit. Before your first visit, ask your insurer whether you have out-of-network benefits for outpatient physical therapy, and what your out-of-network deductible is. Full cost and insurance details.
Can I see a physical therapist without a doctor’s referral?
Yes, for a limited time. In New York, a physical therapist with at least three years of full-time clinical experience (or the equivalent) can evaluate and treat you without a referral.
Before treatment begins, New York requires your physical therapist to give you a written notice explaining that your health plan may not cover treatment without a referral. Many insurance plans will not reimburse treatment without one, so it is wise to check with your insurance carrier before you begin.
Read the state’s direct access FAQs (NYS Office of the Professions) →
Have another question?
Send us a message and we will contact you. You can also call (212) 366-4450 and leave a voicemail.