Direct Access to Physical Therapy

Currently, physical therapy treatment (as rendered by a licensed physical therapist) must be provided pursuant to a referral by a licensed physician, dentist, podiatrist or nurse practitioner. See Education Law § 6731(c). Effective November 23, 2006, however, § 6731(c) is being amended, and subsection (d) is being added, to read as follows, allowing patients some limited direct access to P.T.:

"c. Such treatment shall be rendered pursuant to a referral which may be directive as to treatment by a licensed physician, dentist, podiatrist or nurse practitioner and in accordance with their diagnosis, except as provided in subdivision d of this section.

d. Such treatment may be rendered by a licensed physical therapist for ten visits or thirty days, whichever shall occur first, without a referral from a physician, dentist, podiatrist or nurse practitioner provided that:

1. The licensed physical therapist has practiced physical therapy on a full time basis equivalent to not less than three years.


2. Each physical therapist licensed pursuant to this article shall provide written notice to each patient receiving treatment absent a referral from a physician, dentist, podiatrist or nurse practitioner that physical therapy may not be covered by the patient's health care plan or insurer without such a referral and that such treatment may be a covered expense if rendered pursuant to a referral. The physical therapist shall keep on file with the patient's records a form attesting to the patient's notice of such advice. Such form shall be in duplicate, with one copy to be retained by the patient, signed and dated by both the physical therapist and the patient in such form as prescribed pursuant to regulations promulgated by the commissioner."

However, and most importantly for readers of this blog, it should be noted that the Insurance Law is being modified in such a way as to make P.T. rendered without a referral ineligible for no-fault reimbursement. § 5102(a)(1)(ii) currently defines "basic economic loss" (that which is reimbursable under no-fault) as, inter alia, necessary expenses incurred for "psychiatric, physical and occupational therapy and rehabilitation." Effective November 23, 2006 (the same date as the above-mentioned amendment to the Education Law), however, § 5102(a)(1)(ii) is amended to refer to necessary expenses incurred for "psychiatric, physical therapy (provided that treatment is rendered pursuant to a referral) and occupational therapy and rehabilitation." The end result is that, for no-fault reimbursement purposes, P.T. will still require a referral. Providers, patients, claims examiners, and attorneys should all be aware of these changes and protect their interests accordingly.