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Length of Time a Referral is Valid

Disclaimer: Law, rules and regulations, not Guidelines, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to this Guideline may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations.

Alert 2: Length of Time a Referral is Valid

The Education Law is silent as to the length of time for which a referral is valid. Absent any specific direction regarding duration, it is within the judgment of the physical therapist (PT) to determine the appropriateness of the treatment, including length of treatment based on the type of referral provided. For example, if the referral is specific as to treatment and the treatment is no longer indicated, the PT would be required to contact the referring practitioner to discuss next steps with the patient/client. If a patient/client delays in seeking physical therapy after a referral, the PT should make an initial determination as to whether the ordered treatment is still appropriate and should contact the referring practitioner if there is any question as to the appropriateness of the ordered treatment. Excessive treatment not warranted by a patient/client's condition constitutes unprofessional conduct pursuant to section 29.2(a)(7) of the Rules of the Board of Regents and could result in disciplinary action.

In school settings, unless otherwise indicated, a referral is generally valid for the length of the school year or the duration of the individual education program (IEP). Since the IEP must be re-evaluated each year, the Department generally interprets the referral to be good for one year, unless the IEP or the referral itself provides for a shorter duration.

Many third party payers (insurance companies, Medicare, Medicaid) have referral requirements that may include the length of time a referral is valid that must be met if the PT expects to be reimbursed. And, many employment settings have established guidelines that must be followed that require referrals at different intervals during treatment.

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Citations of Pertinent Law, Rules or Regulations:
Education Law, Section 6731(c) – definition of practice of physical therapy
Regents Rules, Part 29.2(a)(7) – unwarranted treatment