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What’s the difference between a “Prescription” for Physical Therapy & an “Authorization” for Physical Therapy?

  • A prescription (Rx) is a piece of paper given to a patient from a Doctor to go for physical therapy. This is required by the State of New York for these insurances; Medicare, No-Fault, Workers’ Compensation, and HMO’s. Keep in mind these “prescriptions” need to be updated every month or otherwise STATED by the “prescription” (i.e., PT 2x week for 6 weeks).

Patients who have Medicare insurance must have a “prescription” from a Physician that accepts Medicare insurance.

Patients who hold insurances such as Medicare, No-Fault, and Workers’ Comp must have a prescription to be seen at all times. If the prescription does not cover the date that your appointment is on, you will not be able to be seen for Physical Therapy.

  • A referral is generated by a Physician’s office for insurance purposes. Generally this is required by all HMO insurances. This “referral” is not from a specialist like a Neurologist or Orthopedist but by your family Physician (aka Primary Care Physician or Internist). This referral must be generated before you come for your physical therapy evaluation to be covered by insurance.
  • An authorization is generated either electronically or via paper fax to your Insurance Company. It is based upon your subjective complaints as well as the Physical Therapist’s evaluation of your current status. The authorization is then given for treatment and given for a certain amount of visits. If you require more visits, your Physical Therapist will re-evaluate and submit for more Authorization.
  • Direct Access – You may come directly to your Physical Therapist and receive an evaluation and treatment under the “Direct Access” law of NY without a medical Doctor’s prescription. This means we have the ability to see you for up to 10 visits or 30 Days. If treatment is required passed 10 visits or 30 days, you will need a prescription from your doctor to continue your care. (Medicare, No-Fault and Workers’ Comp cannot be seen under the “Direct Access”. Evaluations are only permitted. These Insurances must always have a prescription from a physician to be treated.)
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