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 17: Payment and Physical Therapy
The State Board and Office of Professions usually do not get involved in billing issues. However, we can provide the following guidance.
A licensed physical therapist (PT) meeting the qualifications within the Physical Therapy Practice Act can legally treat a patient/client without a referral for 10 visits or 30 days. Although the PT may have direct access ability, rules/regulations of an employer or a third-party payer may require a referral for payment.
Treatments provided by the physical therapist assistant, student or person on a limited permit under the supervision of a PT are physical therapy services. However, payment may be ultimately tied to the payer contract. Individual payers may have rules or regulations outlined in a contract or the patient/client’s benefit design that indicate it will only pay for physical therapy services when rendered by a licensed PT.