Direct Access to Physical Therapy in Illinois
THE ILLINOIS PHYSICAL THERAPY ACT
Since August 16, 2018, Illinois residents are not required to get a referral from their doctor or other healthcare practitioners to attend physical therapy. The Illinois Physical Therapy Practice Act allows patients to go directly to an Illinois-licensed physical therapist for evaluation and treatment.
Nevertheless, your insurance policy may have different requirements. Prior to your first physical therapy session, you ought to contact your healthcare insurance provider to confirm if you can start your rehabilitation without seeing your doctor for a script. Otherwise, your insurance may deny payments and you will be responsible for the bill.
Some labor funds require a referral from a patient’s PCP before the first appointment or after the evaluation done by a physical therapist. To assure the highest level of accuracy for individual cases, patients should still contact their employer’s healthcare plan to confirm whether a referral is still required. Also, all worker’s compensation plans require prior authorization.
Patients need to note that the law requires a physical therapist providing services without a referral from a health care professional to notify the patient’s treating health care professional (doctor) within 5 business days after the patient’s first visit that the patient is receiving physical therapy.
The patient will also be referred to a healthcare professional under the following circumstances:
- if there is no measurable or functional improvement after 10 visits or 15 business days;
- if a patient returns for services for the same or similar condition after 30 calendar days following being initially discharged by the physical therapist;
- or, a patient whose condition is evaluated and determined to be beyond the scope of practice for physical therapists.