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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.

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Wisconsin PT Direct Access and Referrals

Is a referral required to treat a patient in Wisconsin? 

A licensed PT may practice physical therapy only upon the written referral of a physician, physician assistant, chiropractor, dentist, podiatrist, or advanced practice nurse prescriber.

Are there exceptions to the referral requirement? 

A written referral is not required if a PT provides:

    • Services in schools to children with disabilities pursuant to rules promulgated by the department of public instruction;
    • Provides services as part of a home health care agency;
    • Provides services to a patient in a nursing home pursuant to the patient’s plan of care;
    • Provides services related to athletic activities, conditioning, or injury prevention; or
    • Provides services to an individual for a previously diagnosed medical condition after informing the individual’s physician, physician assistant, chiropractor, dentist, podiatrist, or advanced practice nurse prescriber who made the diagnosis.

A written referral is not required to provide the following services, related to the work, home, leisure, recreational and educational environments:

    • Conditioning.
    • Injury prevention and application of biomechanics.
    • Treatment of musculoskeletal injuries with the exception of acute fractures or soft tissue avulsions.

When the does a PT need to refer a patient? 

A PT shall refer a patient to an appropriate health care practitioner if the PT has reasonable cause to believe that symptoms or conditions are present that require services beyond the scope of the practice of physical therapy.

Reference

Wis. Stat. 448.56

Wis. Admin. Code Trans. PT 6.01

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