Frequently Asked Questions (click on question)
Can I receive physical therapy in New York directly without a doctor’s referral?
A physical therapist with at least 3 years of clinical experience can treat patients directly without a referral but the treatment is limited to 10 sessions or 30 days per episode, whichever comes first. After that a prescription from a MD is required. Most insurance companies require a prescription for reimbursement so it is prudent that you check with your carrier before receiving treatment. For more information see the New York State Department of Professions.
Do you accept a referral for physical therapy treatment from a physician, dentist, podiatrist or nurse practitioner not licensed in New York?
In general, out-of-state physicians, dentists, podiatrists or nurse practitioners who are not licensed in New York may not practice in New York and consequently may not issue prescriptions or referrals for physical therapy to be performed in New York by a New York licensed physical therapist. However, one exemption permits practice in New York by a physician who is licensed in a bordering state and who resides near the border of this state. The border vicinity is usually defined as less than 25 miles. Therefore, a physical therapist may accept a referral from such a physician.
What is the difference between referral, prescription, and authorization?
Prescriptions (often called referrals) are written orders given by a practitioner (MD, DO, NP, DPM, Dentists) to give instructions regarding the administration of physical therapy. Valid prescriptions should contain a date, diagnosis, frequency of treatment, and duration of treatment (e.g., 2x/week for 8 weeks). The prescription is valid from the date administered until the end of the indicated duration. When the visits are exhausted or the time indicated by the duration has passed, it must be renewed for continued treatment. Therefore it is prudent to use it in a timely manner. Most commercial insurances(in/out of network) require a prescription if a patient wants to seek reimbursement for their treatment, regardless of the direct access laws of New York State.
Authorizations, on the other hand, are administered by insurance companies to predetermine the amount of physical therapy they will pay for. They will often require a prescription from a practitioner and written reports from the therapist to make that determination. It should be noted that just because your insurance company allows a certain amount of physical therapy benefits annually, it doesn’t mean they will authorize (and therefore pay) for all of those visits.
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