Upcoming Webinars 

Disclaimer

The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Menu
Log in


Log in

New York PT Referrals and Direct Access 

Referral Requirement

A physical therapist may treat a patient after receiving a referral from an authorized health care provider (physician, (physician's assistant) nurse practitioner, podiatrist, dentist or midwife) licensed and currently registered to practice in New York State. The referral must be within the level of competency and definition of practice for the referring provider.

While a dentist, podiatrist or midwife may refer to a physical therapist, such referral would have to be limited to treatment of a condition within the scope of practice of each of these professions.

Exception to the Requirement

A licensed physical therapist may provide a patient with treatment in the practice of physical therapy without a referral from a physician, dentist, podiatrist, or nurse practitioner, for ten (10) visits or thirty (30) days whichever occurs first, provided the licensed physical therapist meets the following requirements:

    • The licensed physical therapist has practiced physical therapy on a full-time basis equivalent to not less than three (3) years prior to beginning such treatment, meaning the licensed physical therapist has completed at least 4,320 clock hours of physical therapy practice over a minimum of thirty-six (36) months anytime prior to beginning such treatment; and
    • The licensed physical therapist meets all requirements relating to the notice of advice.

A referral is not required for a physical therapist to evaluate or prevent disability, injury, disease or other condition of health. The physical therapist providing preventive care must maintain a record of activities undertaken with each client and these may not be billed as physical therapy treatment.

Notice of Advice

A physical therapist providing treatment in the practice of physical therapy without a referral from a physician, dentist, podiatrist, or nurse practitioner, shall advise the patient in writing prior to beginning treatment of the possibility that treatment may not be covered by the patient's health care plan or insurer without a referral from a physician, dentist, podiatrist, or nurse practitioner and that treatment may be a covered expense if rendered pursuant to such referral. This notice of advice shall be provided on a form, a copy of which shall be kept on file by the licensed physical therapist as a patient record and a copy of which shall be given to the patient. The notice of advice form shall include the following information:

    • A statement of such advice and a statement attesting that the patient has read the notice of advice;
    • The date treatment will begin;
    • The patient’s name and address;
    • The patient’s signature and date the patient signed the form;
    • The treating physical therapist's name and address; and
    • The treating physical therapist’s signature and the date the physical therapist signed the form.

Citation

NYCRR ยง77.9

NY PT Board Guideline 6

Powered by Wild Apricot Membership Software