How Direct Access to Physical Therapy Works (2024)

Direct access to physical therapy means patients can be evaluated and treated by a physical therapist without needing a practitioner or other healthcare provider's referral. In other words, direct access lets you visit a physical therapist when you feel you need to see one.

This article will discuss what direct access is and how it is used for physical therapy services. It will also discuss how direct access differs depending on your health insurance plan and the state where you live.

What Is Direct Access?

Sometimes you may have back or knee pain because of an obvious injury like a sprain or a pulled muscle. Direct access gives you the power to decide if you need physical therapy. Sometimes direct access is called self-referral.

In the United States, each state controls physical therapy services through a "state-practice" act. The practice act is a law that says how physical therapy services can be delivered in that state. Each state lists different professionals who may refer patients to physical therapy, including podiatrists, dentists, and nurse practitioners.

The American Physical Therapy Association (APTA) has helped to change the law in many states to allow patients direct access to physical therapy. By having direct access, patients can see a physical therapist without needing a healthcare provider's prescription first. You can learn more about the kind of direct access your state allows by visiting the APTA's website.

How Direct Access to Physical Therapy Works (1)

Benefits of Direct Access Physical Therapy

Health care is expensive. It seems that with every passing year, more money is being spent on health care. A system that allows the patient to directly seek the services of a physical therapist can help save money by cutting out healthcare provider visits, unnecessary tests, and referrals to other specialists.

Many conditions can be successfully evaluated and treated with no expensive medical tests. Visiting your physical therapist directly allows you to start on treatment right away with very little risk of further injury. Physical therapy is a low-cost, value-packed healthcare service.​

Is Direct Access Safe?

Some people who don't agree with the idea of direct access to physical therapy services argue that patients may be put at risk if they visit a physical therapist on their own. Physical therapists lack the ability to order certain diagnostic tests or prescribe medication to help manage pain.

To date, there is no research showing that self-referral to physical therapy puts patients at increased risk. Also, there is no evidence that self-referred patients spend more on healthcare during or after their physical therapy care visits.

Physical therapists are also trained to spot "red flags" that may point to the need for more extensive medical treatment, such as surgery. In those cases, the physical therapist immediately refers you to your physician or healthcare provider.

There is no evidence that self-referral to physical therapy puts patients at increased risk. Self-referred patients also don't spend more healthcare dollars during or after physical therapy visits.

Many states also have safety nets built into their practice acts. For instance, some states allow direct access only to therapists who have been practicing for three or more years.

Others allow a certain time frame or a specific number of physical therapy visits during an episode of care. If the patient requires skilled physical therapy after the time frame or number of visits is reached, the patient has to see a healthcare provider to continue treatment.

If you have a musculoskeletal condition that interferes with your ability to move without pain, use your best judgment when deciding which healthcare provider to see. A visit to your local physical therapist is a safe place to start on the road to recovery.

Who Can Self-Refer to PT?

How do you know if you can self-refer to physical therapy and get your health insurance to help pay for it? First, take a look at your health insurance policy. Here are some things you should check for:

  • Check if your health insurance policy is a preferred provider organization (PPO) plan. A PPO has a list of preferred healthcare providers but allows you to choose one who isn't on the list. This type of plan also allows patients to self-refer. Unfortunately, it may require higher out-of-pocket costs, meaning you'll have to pay more on your own.
  • Check if your health insurance policy is a point-of-service (POS) plan. A POS plan allows you to pay less for healthcare coverage if the healthcare provider is "in-network." This means that the healthcare provider accepts your health insurance plan. The downside is that POS plans usually require your primary care doctor to refer you to any specialist, including a physical therapist.
  • Check if your health insurance policy is a health maintenance organization (HMO). If you have an HMO plan, you have to choose a primary care doctor within the network. Then the primary care doctor refers you to specialists. Although HMO plans are cheaper than other plans, you can't see a physical therapist without your healthcare provider's referral.

States With Direct Access Policies

Most states have policies about direct access and self-referral. In fact, direct access is available in some form in all 50 states, plus the District of Columbia. The rules differ depending on what state you live in.

You can check the APTA direct access map to see what rules, if any, your state has for direct access. If you are unsure if physical therapy is right for you, a discussion with your healthcare provider may be necessary to help you decide.


Direct access allows you to visit a physical therapist without waiting for a healthcare provider's referral. The level of access you have depends on your health insurance plan and the state where you live. Direct access may provide you with the opportunity to save both time and money since you don't have to see a healthcare provider first.

4 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. APTA. Scope of practice.

  2. Rao B, Hellander I. The widening U.S. health care crisis three years after the passage of ‘Obamacare.’Int J Health Serv. 44(2):215-232. doi:10.2190/HS.44.2.b

  3. Ojha HA, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: a systematic review.Physical Therapy. 94(1):14-30. doi:10.2522/ptj.20130096

  4. NYS Physical Therapy. Office of the Professions: Frequently Asked Practice Questions.

Additional Reading

How Direct Access to Physical Therapy Works (2)

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.

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As a seasoned expert in the field of physical therapy, I bring to the table a wealth of knowledge and practical experience in understanding the nuances of direct access to physical therapy services. My expertise is rooted in years of hands-on involvement, staying abreast of the latest research, and actively contributing to the evolving landscape of physical therapy practices.

Let's delve into the core concepts discussed in the article:

1. Direct Access to Physical Therapy:

  • Direct access allows patients to seek evaluation and treatment from a physical therapist without the need for a referral from another healthcare provider. This autonomy empowers individuals to decide when they require physical therapy services.

2. State-Practice Act and APTA's Role:

  • In the United States, each state governs physical therapy services through a "state-practice" act, specifying how these services can be delivered within that state. The American Physical Therapy Association (APTA) has played a pivotal role in advocating for direct access, influencing changes in state laws to grant patients the right to seek physical therapy without a prescription.

3. Benefits of Direct Access:

  • Direct access is positioned as a cost-effective alternative, saving money by eliminating intermediary healthcare provider visits, unnecessary tests, and referrals. It emphasizes that many conditions can be effectively treated without expensive medical tests, and prompt access to physical therapy can reduce the risk of further injury.

4. Safety Concerns:

  • Addressing concerns about safety, the article asserts that there is no research indicating an increased risk for patients who self-refer to physical therapy. Physical therapists are trained to recognize potential issues ("red flags") that may require more extensive medical treatment, promptly referring patients to healthcare providers when necessary.

5. Eligibility for Self-Referral:

  • The article provides insights into who can self-refer to physical therapy based on their health insurance policy. It discusses the distinctions between Preferred Provider Organization (PPO) plans, Point-of-Service (POS) plans, and Health Maintenance Organization (HMO) plans, highlighting the varying levels of autonomy each offers.

6. State-Specific Direct Access Policies:

  • Direct access policies vary by state, and the APTA's direct access map is recommended as a resource for understanding the rules in a particular state. This underscores the importance of being aware of the regulations in your state when considering direct access to physical therapy.

7. Supporting Evidence:

  • The article references several sources, including peer-reviewed studies, to support the presented information. These sources contribute to the credibility and reliability of the content, reinforcing the evidence-based approach.

In conclusion, the article underscores the significance of direct access to physical therapy, addressing potential concerns, and providing practical guidance on navigating eligibility based on health insurance plans and state-specific policies. My extensive knowledge in the field aligns with the key principles discussed, ensuring a comprehensive and well-informed perspective on the topic.

How Direct Access to Physical Therapy Works (2024)
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