No Need to Wait: The Ins, Outs and Benefits of Direct-Access Physical Therapy

A woman woke up dizzy, with neck discomfort that wouldn’t go away.

A weekend warrior hurt his heel, and the pain initially subsided before returning with increased intensity.

A truck driver with chronic but manageable back issues spent a weekend camping and splitting wood. It triggered a persistent ache, but he couldn’t afford to skip work to rest.

These scenarios played out recently, and all sought the same remedy: They received outpatient physical therapy without a doctor’s prescription. All three are on the mend.

It’s a common question when someone is aching: “Do you need a referral for physical therapy?”

It’s a simple answer: No.

In 2024, more than 60,000 patients throughout the Select Medical Outpatient Division family of brands chose direct-access physical therapy, meaning they received treatment without needing a referral from a physician. The option’s usage continues to climb; Select recorded a 6% increase in direct-access patients in the first half of 2025.

Since 2015, all 50 states permit some form of direct-access physical therapy, including 20 that have no restrictions and 27 more that include access with simple provisions such as visit or time limitations.

Despite its growing popularity, the ability for patients to take more control of their health care decisions and the signs on center windows proclaiming, “no referral needed,” there remains confusion about what direct access is, who benefits from it and how it may positively affect a patient both physically and financially.

Here are some questions – and answers – about direct-access physical therapy.

When should I use direct-access physical therapy?

If you are dealing with a musculoskeletal issue, such as a muscle strain, that causes discomfort but doesn’t require emergency medical attention, you should seek the help of a physical therapist. Even if you think your injury – a rotator cuff tear, for instance – will lead to surgery, you still can schedule an assessment with a physical therapist, who has the experience and education to be considered a musculoskeletal expert.

Once an appointment is scheduled, a clinician will assess your ailment and determine whether treatment can begin immediately or whether you should go elsewhere for imaging or further examination. At times, the initial physical therapy evaluation will discover a more serious problem – a blood clot, for example – and the patient will be sent to an emergency room to avert a potential tragedy. Regardless, if you feel lingering muscle discomfort for days or weeks, don’t wait to see if it stops. No matter the condition, it likely will worsen if untreated.

Why should I seek physical therapy instead of going to my family doctor first?

There are several reasons, the most appealing of which is it’s almost always faster to go the physical therapy route – not only to get an appointment but for initial treatments. Typically, physical therapy can begin the same day as your evaluation. The quicker you are examined and treated, the less likely it is the injury will worsen and the more likely it will heal faster.

In most cases, a center can schedule treatment within 48 hours of calling for an appointment; in contrast, depending on scheduling, sometimes it takes weeks or more to see a physician. Oftentimes, if it is a musculoskeletal issue, the doctor will send you to physical therapy anyway.

Therefore, the biggest advantage of direct access is it empowers patients to initially choose the path of treatment they believe can help them feel better the quickest.

Is this a new concept?

No. Nebraska became the first state to approve direct-access physical therapy in 1957 and California followed in 1968. Many states have adopted or updated regulations within the past 25 years. The most common stipulation requires a doctor’s involvement or a doctor’s prescription after 30 days of treatment to continue physical therapy, but that is usually a seamless process between the two offices. Besides, after 30 days, physical therapy patients are often well on their way to recovery.

Does it cost extra to use direct access?

No. In fact, if you have an insurance co-pay, it may save you a little money since there will be one fewer appointment to attend if you skip a physician exam and go directly to physical therapy. Otherwise, using direct access will cost the same as being referred by a doctor.

Will direct access work with my insurance company?

Every situation is different, but, generally, if your insurance covers physical therapy sessions with a prescription, it will also cover sessions initiated by direct access at the same rate.

If you are not sure about your insurance company’s policy, contact one of our centers and ask for a patient service specialist, who will research insurance compatibility and explain billing options.

How do I go about setting up a direct-access appointment?

Simple. Call your local center and tell a patient service specialist you would like an appointment but do not have a prescription. The specialist will set you up for your assessment.

You also can walk directly into a center, but depending on workload, you may not be able to see a clinician that day. Again, a patient service specialist will work with you to schedule an appointment as soon as possible.

What if I use direct access and, after assessment or some treatment sessions, the physical therapist sends me to a physician for imaging or more evaluation? Isn’t that a wasted step?

Technically. In that instance, however, the therapist likely suspects a bigger issue that could require surgery. Studies have shown one of the most important steps in surgery recovery is having prehabilitation physical therapy before an operation.

Additionally, some insurance companies require “conservative treatment” prior to approving surgery. That typically means participating in a specified number of physical therapy sessions to determine if the issue can be resolved without an expensive operation. Those sessions already would have started if a patient began the process via direct access.

Ultimately, a physician or surgeon may have to get involved, but being assessed by a musculoskeletal expert and going through physical therapy before surgery is never wasted time.

Is there anything else I should ask when setting up a direct-access appointment?

You should clarify with the patient services specialist that the center has a clinician with proper licensing for direct access. For a physical therapy license renewal, a clinician must log 30 hours of continuing education during a two-year period. To obtain a direct-access license, 10 of those hours must include direct-access training. It’s a common certification among therapists, but it is best to check before you physically go to a center.

What’s the bottom line?

Overall, direct access can save a patient time and, potentially, money while accelerating the healing process. The faster you are treated once an injury occurs, the better chance there is of returning to the good health you desire.

Clinical contribution to this blog provided by Physical Therapist Daniel P. Collins.