Anyone dealing with a shoulder problem, a sore knee, or lower back pain that won’t quit may assume they need to head to a doctor’s office first. In Missouri, that isn’t always necessary. A change to state law means many patients can start physical therapy without first getting a physician’s prescription or referral.
Missouri Allows Direct Access to Physical Therapy
Missouri now permits what’s called “direct access.” Under the law, qualifying physical therapists can evaluate and begin treating patients without a referral from a physician.
The change took effect in August 2023. To provide treatment through direct access, a physical therapist must have a Doctor of Physical Therapy degree or at least five years of clinical practice as a physical therapist.
For patients, direct access means a new injury, a flare-up of an old problem, or pain from everyday activity may be evaluated without waiting for a doctor’s appointment first.
At PEAK Sport & Spine, many of our Missouri physical therapists meet the state’s requirements to provide care through direct access, including therapists with Doctor of Physical Therapy degrees and experienced clinicians who have practiced for more than five years. If you’re unsure whether direct access is available at your local PEAK clinic, contact the clinic before scheduling.
Why Direct Access Matters
Depending on your physician’s availability, getting an appointment can take days or weeks. Direct access allows patients to schedule a physical therapy evaluation sooner and begin addressing pain, mobility problems, weakness, or other musculoskeletal concerns.
A physical therapist can evaluate the problem, determine whether physical therapy is appropriate, and develop a treatment plan when needed. If the therapist finds signs that the condition requires medical evaluation or treatment outside the scope of physical therapy, they’ll refer the patient to the appropriate health care provider.
The Limits of Direct Access
Direct access in Missouri doesn’t allow treatment to continue indefinitely without involvement from another health care provider.
If a patient hasn’t demonstrated measurable or functional improvement within 10 visits or 30 days, whichever comes first, the physical therapist must refer the patient to an approved health care provider and stop treatment.
If the patient is improving and continued physical therapy is reasonable and necessary, the therapist must consult with an approved health care provider before continuing treatment. During longer courses of care, the therapist generally must continue communicating with that provider at least every 10 visits or 30 days unless the provider directs otherwise.
Under Missouri law, an approved health care provider can include a physician, chiropractor, dentist, podiatrist, physician assistant, advanced practice registered nurse, or another qualifying provider.
Treatment through direct access must also remain within a physical therapist’s scope of practice. If an evaluation points to a condition that requires care outside that scope, the therapist will refer the patient to another provider.
Your Insurance May Have Separate Requirements
Missouri’s direct access law determines whether a referral is legally required to begin physical therapy. Your health insurance plan may have its own requirements for coverage.
Some insurance plans require prior authorization before they will cover physical therapy services. Prior authorization means the insurer must approve the treatment before certain services or additional visits are covered. Other plans may require a referral or have limits on the number of covered visits.
Medicare patients may also have additional requirements involving certification of the physical therapy plan of care.
Coverage requirements vary by insurance plan. PEAK accepts major insurance carriers and can verify your coverage before treatment, including whether your plan requires a referral or prior authorization.
When a Referral Still Helps
Even when a referral isn’t legally required, having another health care provider involved may be helpful in situations such as:
- Recovering from surgery, such as a knee or hip replacement, when the surgeon has provided a specific rehabilitation protocol
- Managing a complex or chronic condition involving multiple health care providers
- Using an insurance plan that requires a referral or prior authorization
- Dealing with a condition where imaging or additional medical evaluation may help guide treatment
Getting Started with Physical Therapy
If you’re dealing with pain or an injury and aren’t sure whether you need a referral, contact your local PEAK Sport & Spine clinic. Our team can help determine whether direct access is appropriate and check your insurance requirements before your first visit. To get the most out of that first evaluation, check our guide on what to wear to physical therapy.
Find a location near you and schedule an evaluation today to get started.
