No, California does not require a referral to start physical therapy: Business and Professions Code section 2620.1 lets you keep going without one for up to 45 calendar days or 12 visits, whichever comes first. After that, you need a referral from your doctor to continue, and Medicare patients need a referral from the start.
The two rules: 45 calendar days and 12 visits
Starting physical therapy without a referral from your doctor is called direct access. California allows it, with two limits set out in California Business and Professions Code section 2620.1 (read it on Justia).
- Limit one: 45 calendar days.Every day on the calendar counts, weekends included.
- Limit two: 12 visits.This one counts appointments, not days.
- Whichever comes first.Come often and you reach 12 visits before day 45. Come less often and day 45 arrives before your twelfth visit. The earlier one is your limit.
The count does not reset on its own. After 12 visits you need a referral to keep going, and if a new problem starts after you finish, you need a referral to be seen through insurance, especially with Medicare.
Until you reach that limit, you can book and start treatment without a referral. You do not have to see your doctor first.
What happens at the limit
At the limit, treatment can go on only with your doctor's approval of the physical therapist's plan of care. The clinic calls this a referral. Under section 2620.1, the approval is a dated signature on the plan of care, from a physician and surgeon or a podiatrist.
Section 2620.1 also says the approval must include an in-person or telehealth examination and evaluation of your condition, and testing if it is indicated. In plain terms, getting the referral means an appointment with your doctor.
Dr. Ed does not guess at the number of visits up front. It depends on your condition and how your body responds, so he sets the plan after your first evaluation. Since treatment cannot continue past the limit without the approval, it helps to see your doctor before you reach it.
Medicare is the exception
Medicare patients need a referral from the start, so the 45-day and 12-visit window does not apply. Medicare's page on physical therapy services says your doctor or other health care provider "must certify that you need it."
If you have Medicare, ask your doctor for the referral and bring it to your first visit.
What the law says, and how Dr. Ed puts it
The limits come from California Business and Professions Code section 2620.1 (read it on Justia). The key passage says the physical therapist "shall not continue treating the patient beyond 45 calendar days or 12 visits, whichever occurs first" without receiving "a dated signature on the physical therapist's plan of care indicating approval of the physical therapist's plan of care."
The same section sets a rule for any point in treatment. If the physical therapist has reason to believe you have signs or symptoms of a condition that needs treatment beyond a physical therapist's scope of practice, or that you are not progressing toward documented treatment goals as shown by objective, measurable, or functional improvement, the physical therapist "shall refer the patient to a person holding a physician and surgeon's certificate" or to a dentist, podiatrist or chiropractor.
Direct access does not widen what a physical therapist may do. The section "does not expand or modify the scope of practice for physical therapists set forth in Section 2620, including the prohibition on a physical therapist diagnosing a disease."
Nor does the section require your health plan to cover direct access. Subdivision (d) says nothing in the section "shall be construed to require a health care service plan, insurer, workers' compensation insurance plan, employer, or state program to provide coverage for direct access to treatment by a physical therapist." Whether your plan pays without a referral is a question for the plan.
Here is how Dr. Ed states the rule at the clinic:
"California law lets you see a physical therapist without a referral for up to 12 visits or 45 days, whichever comes first. After that, we need a referral from your doctor to continue. Medicare patients need a referral from the start."
What to do next
If you are not on Medicare, you can book now without a referral. If you are on Medicare, get the referral from your doctor first. The Insurance and cost page has the details on insurance and payment. If you are not sure where you stand, say so on the form below.