One of the most common questions from someone looking into physical therapy is: “Do I need a referral to see a physical therapist?” This article will lay out key facts so you can move forward confidently with a physical therapy clinic like REPAIR SI.
What a referral is (and why it matters)
There are two types of referrals: physician and direct access. A physician’s referral is a formal request from one doctor to another for a patient to see a specialist. Direct access allows a patient to see a specialist, like a physical therapist, without a prior referral. However, depending on each state’s laws, insurance and clinic policies may affect whether you need a referral for physical therapy.
5 key facts about whether you need a referral for PT
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Understand that many states allow direct access to PT without a referral.
For example, in California, a referral is not always needed. This law allows patients to see a physical therapist for up to 45 days or 12 visits without a doctor’s referral.
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Know that some insurance plans still require a referral for coverage.
Even in direct access states, certain plans like Medicare may require a doctor’s referral.
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Confirm your clinic’s policies, which may differ from state and insurance rules.
Each clinic’s requirements may differ. Some allow full direct access, while others may prefer documentation for more complex injuries.
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Ask key questions before you schedule your first appointment.
If talking with your clinic or insurance company before scheduling an appointment, ask specific questions such as:
- “Do I need a referral for my plan or condition?”
- “Will my insurance cover direct access visits?”
- “Are there limits on the number of visits without referral?”
- “What paperwork is needed for injury, accident or workers’ comp claims?”
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Prepare for what your clinic requires before your first visit.
REPAIR SI accepts insurance and self-pay, and we offer consultations before your first appointment. Bring your ID, insurance card, and any prescription or accident claim paperwork.
Why starting early (even without referral) can be beneficial
While referrals may or may not be required depending on state/insurance, you can move forward with confidence by asking the right questions and choosing a provider that offers clarity and support. At REPAIR SI, all initial consultations begin with a full-body functional movement assessment. Whether or not you have a referral, early interventions may lead to better outcomes. You can avoid unnecessary delays or chronic pain by reaching out to a physical therapist as soon as possible. Contact our team today for more information or to schedule an initial appointment.