Short Answer: In the U.S., most people don’t need a referral to start physical therapy because every state now allows some form of direct access to a physical therapist. However, exact rules (like how long you can be seen before needing a doctor’s sign-off) vary by state, and your insurance or clinic may still ask for a referral. For Medicare, you typically don’t need a referral, but your therapist’s Plan of Care must be certified (signed) by a physician or allowed practitioner for Medicare to pay.
What “Direct Access” Really Means
Direct access lets you see a licensed physical therapist for an evaluation—and in many states for treatment—without seeing a doctor first. All 50 states (plus D.C. and U.S. Virgin Islands) have some version of this, but details differ: some places limit the number of visits or days before a referral is needed, or they require extra experience for the PT who treats you without referral. Check your state’s rules on the APTA map.
Example: New York’s Rule (Useful If You’re In NYC)
In New York, a PT with 3 years of full-time experience may treat you without a referral for up to 10 visits or 30 days—whichever comes first. The PT must also give you a Notice of Advice explaining that some insurers may not cover treatment without a referral. After the limit, a referral from a physician, podiatrist, dentist, or nurse practitioner is required to continue.
Looking up “Free sports physicals in NYC” and care access recently? The same public-system clinics that do school or sports exams often provide physical therapy and can tell you whether direct access applies to your situation.
Medicare: Do I Need A Referral For Physical Therapy With Medicare?
Here’s the simple version:
No standard referral is required just to walk into PT under Original Medicare.
For Medicare to pay, the therapy Plan of Care (POC) must be certified (signed and dated) by a physician or non-physician practitioner (like an NP or PA). Initial certification should be obtained as soon as possible, and no later than 30 days after the first therapy treatment (the evaluation counts as treatment). Recertification rules apply if care continues.
Two useful nuances:
Under Medicare policy, chiropractors and dentists can’t certify therapy plans of care (they’re not considered “physicians” for therapy coverage). Your PT will route the plan to an eligible signer if needed.
New for 2025: CMS created a limited exception to the initial POC signature requirement in the 2025 Physician Fee Schedule. Ask your clinic how they’re implementing it.
Related Article: Physical Therapy in NYC That Accepts Medicare
Insurance Reality Check (Commercial, Medicaid, HMOs)
Even where state law allows treatment without referral, your insurance might still require a referral or prior authorization for payment. Many PPOs don’t, but some HMO/Medicaid plans do. Quick script when you call your plan:
“I’m scheduling outpatient physical therapy. Do I need a referral or prior auth for payment? If yes, who can issue it and what CPT codes are covered for the evaluation and first visits?”
If you’re paying cash, direct access often still applies—ask the clinic about self-pay rates.
How To Start (With Or Without A Referral)
Pick a clinic and ask: “Do you accept direct access patients?”
Describe your issue and any red-flag symptoms (sudden severe pain, trauma, numbness, chest pain, unexplained weight loss, etc.). PTs are trained to screen and will refer you to a medical provider when appropriate.
Bring your meds list and prior imaging or notes.
If you have Medicare: the clinic will send your Plan of Care to a physician/NP/PA for certification so your visits are covered.
NYC Spotlight: Where Can I Get Seen Fast?
If you’re here for “do i need referral for physical therapy” and you’re in NYC:
Public System (H+H): Large network across all boroughs; ask about direct-access appointments and sliding-fee options if you’re uninsured (NYC Care).
Neighborhood Clinics / FQHCs: Many accept direct access and can advise on whether your plan wants a referral.
Private Practices: Many welcome direct-access patients; they’ll tell you if your plan requires a doctor’s order to bill.
Search your state rule first on the APTA Direct Access map, then call two local clinics and ask specifically about direct-access evals and what your plan requires.
FAQs
Do I Need Referral For Physical Therapy?
Usually no—thanks to direct access in all 50 states. But your insurer/clinic may have its own rule, and some states cap the number of visits/days you can be seen before a referral is needed.
Do I Need A Doctor Referral For Physical Therapy?
If your state’s direct-access law allows treatment (not just evaluation), you can begin without a doctor’s order. That said, many clinics still like a referral when complex medical issues are involved, and some HMO/Medicaid plans require it for payment.
Do I Need A Referral For Physical Therapy With Medicare?
Not typically for the first visit. But for Medicare to pay, your PT’s Plan of Care must be certified by an eligible practitioner (physician/NP/PA). Clinics handle this routinely; the initial certification should be obtained within 30 days of the first treatment.
New York Example: How Many Visits Can I Do Without A Referral?
In New York you can be treated up to 10 visits or 30 days (whichever comes first) by a PT with 3+ years of experience. After that, you’ll need a referral to continue. If you’re paying through insurance, the PT must also give you a Notice of Advice about coverage.
When A Referral Is A Good Idea Anyway
You have red-flag symptoms (fever with severe back pain, unexplained weakness, chest pain, new neurological changes).
You’ve had recent surgery or complex medical conditions that need coordinated care.
Your plan requires a referral and you want the visits covered.
One-Page Checklist
Check your state on the APTA Direct Access map.
Call your plan: “Referral or prior auth needed for PT?”
Book a clinic; mention direct access if you don’t have a referral.
Bring meds list, imaging, and questions.
Medicare? Make sure the clinic will submit the Plan of Care for certification within the 30-day window.
A Few Helpful, Official Links
Direct Access By State (APTA): jurisdiction rules at a glance.
NY (Official) — Practice Alert: Treat up to 10 visits/30 days without referral; Notice of Advice required.
Medicare Manual (CMS): Plan of Care certification timing (initial within 30 days; recert rules).
This article is for general information only and isn’t medical or legal advice. Always follow your local laws and your health plan’s rules.