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One of the most common questions we hear at Physical Therapy Now is:
“Do I need a referral from my doctor to start physical therapy?”

The answer depends on where you live and your insurance plan—but in many cases, the answer is: NO, you don’t!
Thanks to something called Direct Access, patients in many states can go straight to a licensed physical therapist without needing a physician’s referral. Direct Access means you have the legal right to seek evaluation and treatment from a physical therapist without a referral from a doctor or specialist. It’s designed to give patients quicker access to care—especially important when you’re in pain or recovering from an injury. As of now, all 50 U.S. states allow some form of Direct Access, although the rules vary slightly from state to state. Skipping the referral process can save you time (no waiting for another doctor’s appointment), start your recovery sooner and reduce out-of-pocket expenses,especially if a doctor visit would cost you extra. It puts you in control of your health and recovery without unnecessary delays.

Even though Direct Access is allowed in many cases, your insurance plan might still require a referral or prescription to approve coverage. Here’s when you might need one: If your insurance mandates a referral for reimbursement, if you’re covered by Medicare, which often requires documentation from your physician and if your state has restrictions. You don’t always need a doctor’s referral to start physical therapy—and that’s great news if you’re ready to feel better, move better, and get back to doing what you love. Thanks to Direct Access, many patients can begin treatment right away.

¨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/¨

What you need to know before starting treatment. If you’re considering physical therapy to recover from an injury, manage chronic pain, or improve mobility, you might be wondering: “Is physical therapy covered by my insurance?” The good news is that in most cases, yes. Most major health insurance plans—including Medicare, Medicaid, and private insurers like Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield—do cover physical therapy services. Coverage usually depends on:
Medical necessity

A referral or prescription from your doctor

Your plan’s deductible and copayments

Depending on your insurance plan and state laws: Some plans require a referral from your primary care doctor or a specialist. Others allow direct access, meaning you can schedule an evaluation with a physical therapist without a referral. In the clinic, the front desk person always verifies your coverage and referral requirements before your first visit—so there are no surprises. If you don’t have insurance, that doesn’t mean you can’t get care. Here at Physical Therapy Now, we offer: Affordable self-pay rates, discounted therapy packages, flexible payment plans. Your health shouldn’t have to wait because of coverage issues. Our goal is to make your experience easy, affordable, and stress-free. If you’ve been putting off therapy because of insurance questions, we’re here to help.
Call your nearest Physical Therapy Now clinic and we’ll walk you through your benefits, coverage, and options—so you can start your recovery journey today.

In today’s fast-moving world, convenience and access to healthcare are more important than ever. At Physical Therapy Now, we’re proud to be at the forefront of innovation in patient care—including the integration of telehealth physical therapy across our franchise locations nationwide.

Why Telehealth in Physical Therapy?
Telehealth isn’t just a trend—it’s a transformative tool that breaks down barriers to care. Whether a patient is managing a chronic condition, recovering from surgery, or looking for mobility solutions, virtual physical therapy offers safe, effective, and flexible care from the comfort of home.

Here’s how we’re making it work for our patients and franchisees:

1. Personalized Virtual Evaluations
Our telehealth platform allows licensed physical therapists to perform comprehensive initial evaluations via secure video sessions. Using guided assessments and patient-reported symptoms, we create customized care plans that mirror the precision of in-person visits.

2. Home-Based Exercise Programs (HEPs) with Real-Time Coaching
Through live telehealth sessions, our PTs guide patients through their home exercise programs, providing real-time corrections, encouragement, and education to ensure proper form and progress. These sessions increase accountability and drive better outcomes.

3. Post-Operative Check-Ins & Pain Management
Post-op recovery can be stressful. We offer virtual follow-ups to monitor healing, adjust rehab plans, and provide support—especially valuable for patients with limited mobility or transportation challenges.

As physical therapy evolves, many patients and providers alike wonder: Can physical therapists perform diagnostic services, particularly for Medicare patients? The short answer is yes — under specific conditions. Physical therapists can perform certain diagnostic tests on Medicare patients, but only if they are board certified in clinical electrophysiology by the American Board of Physical Therapy Specialties (ABPTS). Additionally, the service must be permitted under the physical therapist’s state law.
Medicare (CMS) recognizes board-certified PTs to provide the following tests:
1. Electromyography (EMG)
This test measures muscle response or electrical activity in response to nerve stimulation of the muscle.
2. Nerve Conduction Velocity (NCV)
Used to assess how fast electrical signals move through your peripheral nerves.
3. Sensory Evoked Potentials (SEPs)
Tests how the brain responds to sensory input like sight, sound, or touch — often used to evaluate neurological disorders.
Diagnostic testing like EMGs, NCVs, and SEPs can play a crucial role in identifying the source of pain or dysfunction — helping physical therapists create more targeted treatment plans. When performed by a board-certified clinical electrophysiology specialist, these services are recognized and reimbursable under Medicare, as long as your state law allows it. Physical therapists who are board certified in clinical electrophysiology have a unique opportunity to expand their scope of services by offering diagnostic testing such as EMGs, NCVs, and SEPs — with full recognition and reimbursement from Medicare, provided state laws permit it. These services not only support more precise treatment planning but also reinforce the role of physical therapists as key contributors in the diagnostic process.

Understanding how often you can submit claims for outpatient therapy services depends largely on the classification of your practice or organization. This blog explores the guidelines for submitting claims to both Medicare and commercial insurance carriers and clarifies which therapy settings are eligible for daily submissions versus monthly submissions.

Outpatient therapy services can be provided in various settings, including private practices (therapist or physician-owned), Outpatient Rehabilitation Facilities (ORFs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), and hospital outpatient departments. However, not all these settings follow the same billing rules.

For Medicare claims, settings that submit on a CMS-1500 claim form—like private practices and certain hospital therapy departments—can submit claims daily to their Medicare Administrative Contractor (MAC). In contrast, settings that use the UB-04 claim form—like ORFs, CORFs, SNFs, HHAs, and most hospital outpatient departments—must submit claims monthly or after the conclusion of services within a given month. When billing commercial insurance carriers, the rules are similar. Organizations using the 1500-claim form (such as private practices and non-provider-based hospital departments) can generally submit claims daily. However, those submitting via UB-04 (such as SNFs, HHAs, and standard hospital outpatient departments) must follow monthly submission protocols.

When a therapist—whether a full-time employee or a traveling clinician—leaves a practice, it’s not uncommon to discover unfinished documentation, such as a missing discharge report. One of the most frequently asked questions in this scenario is whether another therapist who never treated the patient can write the discharge report based solely on the existing notes in the medical record. Technically, the answer is yes—another licensed therapist could write the discharge summary. However, the real question is: should they?

Any therapist who signs their name and credentials on a discharge report becomes part of that patient’s case, regardless of whether they ever interacted with the patient directly. This can present several concerns. If an insurance company requests the records, or if the patient has an active workers’ compensation claim, pending lawsuit, or any other legal matter related to their care, the therapist who authored and signed that report could be pulled into the case. Without firsthand knowledge of the patient’s condition, progress, and outcomes, the substitute therapist may be at a disadvantage in justifying the clinical decisions or summarizing the treatment provided. While it’s permissible for a different therapist to write the discharge report based on existing documentation, it’s important to weigh the potential risks. Ideally, the therapist who evaluated and treated the patient should complete the discharge report. If that’s not possible, practices should implement a clear policy and ensure thorough internal documentation to protect both clinicians and the integrity of patient care.

Patients who began treatment before January 1, 2025 now have a new insurance plan for dates of service on or after that date. A frequent question that arises is whether a new evaluation is required when a patient switches insurance during an ongoing episode of outpatient therapy.

The good news is that in most cases, a new evaluation is not required simply because the patient changed insurance. The key exception is if the new insurance carrier specifically mandates a new evaluation. However, providers should be aware that the new insurance may require prior authorization to continue therapy services, even if a new evaluation is not necessary.

For patients who switch to original Medicare, a new evaluation is not required or appropriate. What is required, however, is a signed and dated plan of care starting from the first date of service billed to Medicare. This plan must be completed by the treating therapist and signed by the referring physician or nonphysician practitioner (NPP) responsible for overseeing the patient’s care. Also, keep in mind that this first visit under Medicare will count as visit one toward the 10-visit minimum progress report period.

If the patient transitions to a Medicare Advantage (MA) plan, a new evaluation is also not typically required, unless the MA plan has a policy stating otherwise. However, similar to private insurance carriers, prior authorization may be necessary for dates of service under the new plan. It’s crucial to confirm the requirements of the specific MA plan to ensure compliance and avoid reimbursement delays.

In summary, while changing insurance during treatment doesn’t automatically require a new evaluation, it does often involve verifying prior authorization and updating documentation to align with the new payer’s policies. Staying ahead of these administrative steps helps ensure uninterrupted patient care and proper reimbursement.

When treating a patient for one condition, such as neck pain, who later returns with a new physician order for a different issue like shoulder pain, your next steps depend on clinical judgment. If the therapist determines the shoulder condition is related to the neck, a reevaluation may be appropriate. However, if the shoulder issue is completely unrelated, a new evaluation should be performed. Keep in mind that whether a second evaluation is reimbursable depends on the specific insurance carrier. For Medicare beneficiaries, your plan of care will vary based on the referring physician(s). If the same physician referred the patient for both issues, you can create an updated plan of care that includes both conditions and obtain a dated signature from that physician. If two different doctors are involved one for the neck and one for the shoulder—you have two options: either one physician agrees to assume responsibility for both conditions and signs a combined plan of care, or you must maintain two separate plans of care, each with the appropriate physician’s certification and recertification. In such cases, it may be helpful to document separate treatment notes if both conditions are addressed during the same visit. Furthermore, if the neck treatment is billed to Insurance A and the shoulder treatment to Insurance B, the shoulder should be considered a separate episode, requiring a new evaluation and separate medical records for each condition. Proper documentation and compliance with insurance policies are essential to ensure accurate billing and optimal patient care.

As a private practice owner who has chosen to operate out-of-network (OON) with insurance companies, one of the most important billing decisions you’ll face is whether to submit claims to insurers on behalf of your patients or provide them with a superbill for self-submission. If you decide to submit the claim yourself, you have two options: accept assignment or not accept assignment. Accepting assignment means the insurer pays you directly for the portion they cover, and the patient pays only their cost-sharing amount (copay or coinsurance). However, keep in mind that insurers aren’t required to honor assignment and may still send the payment to the patient. If you choose not to accept assignment, the patient pays your full rate upfront, and the insurer reimburses them directly for the covered portion—this is common with PPO plans but may not apply to Medicare Advantage or TRICARE plans. Alternatively, if you don’t want to submit any claims at all, you can either give the patient a superbill or simply charge your cash rate and provide no documentation for reimbursement. A superbill is an itemized receipt that includes essential details like diagnosis codes (ICD-10), service codes (CPT), charges, provider and therapist information, and patient identifiers. This allows the patient to seek reimbursement directly from their insurance carrier.

Después de un accidente, ya sea de auto, laboral o una caída, es común que las personas piensen que la cirugía es la única solución para aliviar el dolor o recuperar la movilidad. Sin embargo, en muchos casos, la fisioterapia puede ser una alternativa efectiva y menos invasiva.
¿Qué es la fisioterapia y cómo ayuda?
La fisioterapia es un tratamiento médico que utiliza ejercicios, movilizaciones, técnicas manuales y tecnología para ayudar al cuerpo a sanar de forma natural. Después de un accidente, la fisioterapia puede:
• Reducir el dolor y la inflamación
• Recuperar fuerza y movilidad
• Mejorar la postura y el equilibrio
• Reeducar músculos y articulaciones lesionadas
• Prevenir la formación de tejido cicatricial inadecuado
Muchas lesiones como latigazos cervicales, hernias discales, esguinces, lesiones musculares o articulares pueden sanar completamente con fisioterapia, evitando la necesidad de procedimientos quirúrgicos costosos, riesgosos y con largos tiempos de recuperación.
Además, incluso si la cirugía termina siendo necesaria, haber hecho fisioterapia previamente acelera la recuperación postoperatoria.

Si usted o alguien que conoce necesita terapia física, por favor llámenos al 305-570-1633.
Si está interesado en abrir una franquicia de Physical Therapy Now, envíenos un correo a franchise@physicaltherapynow.com o visite nuestro sitio web en www.physicaltherapynow.com/franchise.

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