As more states across the U.S. adopt direct access laws, allowing patients to see a physical therapist without a doctor’s referral, many Medicare beneficiaries are asking:
“Can I start physical therapy without a referral under Medicare?”
The answer is not quite. While state laws may allow direct access, the Medicare program has its own rules when it comes to outpatient therapy services. Direct access means you can visit a licensed physical therapist without a physician’s referral or prescription. Most states support this model, giving patients faster, more convenient access to care—especially for issues like back pain, joint stiffness, or post-surgical recovery. However, Medicare operates under a federal program, and its payment rules are separate from state licensure laws.
The Medicare program does not formally recognize direct access for outpatient physical, occupational, or speech therapy services. This means Medicare requires specific documentation from a physician or nonphysician practitioner (NPP) to reimburse therapy services, even if state laws allow direct access. But that doesn’t mean you can’t start therapy. If your state allows direct access, a Medicare beneficiary can be evaluated by a therapist without a referral.
Medicare doesn’t officially recognize direct access the way private insurance might, but that doesn’t mean you can’t start therapy without a referral. The key is making sure all necessary documentation and physician certification are in place to ensure coverage.
¨If you or someone you know might need physical therapy, please call us at 305-570-1633, or if you are interested in opening a Physical Therapy Franchise. Email us franchise@physicaltherapynow.com or visit our website at https://physicaltherapynow.com/franchise/
