Can You See a Physical Therapist Without a Referral in California?
Yes. Under California law, you can start treatment with a licensed physical therapist (PT) without a doctor's referral. You can receive up to 12 visits or 45 calendar days of care, whichever comes first. After that, a physician or podiatrist must examine you and sign your PT's plan of care so treatment can continue.
Quad Therapy Inc. is a California therapy company founded by a licensed physical therapist. We provide in-home therapy so patients can get care without clinic wait lines, and we place qualified therapists with clinics, schools, and facilities that need staff.
Key facts
You may get up to 12 visits or 45 calendar days of PT without a referral, whichever comes first.
To keep going, an MD, DO, or podiatrist examines you (in person or by telehealth) and signs the plan of care.
Wellness-only services and school or early-intervention PT under an IEP or IFSP do not have the 12-visit, 45-day limit.
No California law requires your insurance plan to pay for PT you start without a referral.
Medicare does not require a referral, but a physician or other qualified practitioner must certify your plan of care within 30 days.
What does "direct access" mean in California?
Direct access means you can book a physical therapist yourself, without a doctor's referral or prescription. California has allowed this since January 1, 2014, and the rules are written in Business and Professions Code section 2620.1.
Two terms come up often. An evaluation is the first visit, where the PT checks how you move and asks about your health history. A plan of care is the written plan that follows, with your goals, treatment, and visit schedule.
Direct access does not change what a PT is allowed to do. A PT still may not diagnose a disease. Your PT evaluates and treats movement problems, such as back pain, a stiff shoulder, or poor balance.
How many visits can I have without a referral?
You can have up to 12 visits or 45 calendar days of physical therapy, whichever comes first, before a physician or podiatrist needs to approve the plan. At 3 visits a week, you reach 12 visits in about 4 weeks. At 1 visit a week, day 45 comes first.
To continue past that point, an MD, DO, or podiatrist must sign and date your PT's plan of care. Since a 2022 update (SB 1438, in effect January 1, 2023), that approval must include an exam of you by the physician or podiatrist, and the exam can be done in person or by telehealth.
Which services do not have the 12-visit, 45-day limit?
Two kinds of care are exempt from the time limit. The first is wellness physical therapy, meaning services to keep you fit and moving well rather than to treat an injury or condition. The second is PT given under a child's Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP), when the child does not have a medical diagnosis. AB 2423 (2018) added that second exception.
What must a PT tell me before treatment starts?
Before the first treatment, your PT must read you a notice about the 12-visit, 45-day rule, give it to you in writing in at least 14-point type, and have you sign it.
The same section of the law asks for two more things. Your PT must tell you about any financial interest they have in treating you. With your written permission, the PT must also let your own doctor know you are in physical therapy. If any of this is skipped at your first visit, it is fair to ask about it.
When will a physical therapist send me to a doctor?
A PT must refer you to a physician, dentist, podiatrist, or chiropractor if your signs or symptoms point to a problem outside physical therapy, or if you are not making measurable progress toward your goals. This is a legal duty under section 2620.1(a)(1), not a choice.
PTs screen for red flags, which are signs that a symptom may come from something that needs medical testing, such as an infection or a problem with an organ. A 2025 review of clinical practice guidelines found that guidelines agree red flags call for testing or referral, but do not fully agree on which signs belong on the list. Your PT should explain the reason if they refer you.
If you have chest pain, sudden weakness or numbness on one side of the body, trouble breathing, or new loss of bladder or bowel control, do not wait for a therapy visit. Call 911 or go to the nearest emergency room.
Will insurance pay for physical therapy without a referral?
Maybe. The law lets you see a PT without a referral, but it does not require any health plan, insurer, workers' compensation plan, or state program to pay for it. Call the member number on your insurance card before your first visit.
Private plan (PPO or HMO): Depends on the plan. HMOs often require one. Call the number on your card and ask if PT needs a referral or prior authorization.
Medicare Part B: No referral, but a physician or qualified practitioner must certify the plan of care within 30 days. Give your PT your doctor's name so the plan can be sent for signature right away.
Workers' compensation: The law does not require coverage of direct access. Ask your claims adjuster before starting.
Self-pay: No referral to pay. The 12-visit, 45-day rule still applies. Ask for the price per visit in writing.
Medicare has not required a physician visit before PT since 2005, according to the American Physical Therapy Association. CMS guidance says the first plan is certified within 30 calendar days of the first treatment and recertified at least every 90 days. California's 12-visit, 45-day rule applies at the same time.
Does seeing a PT first work as well as seeing a doctor first?
For common muscle and joint problems, studies show similar or better results at a lower cost. Most of this research is observational, meaning patients chose their own path instead of being randomly assigned, so the evidence is promising but not final.
A 2021 systematic review in Disability and Rehabilitation found no difference in pain, but better function, quality of life, and lower costs with direct access in several studies. The authors rated the evidence weak to moderate.
A 2023 systematic review in the Journal of Clinical Medicine found direct access cost less and gave better work outcomes and satisfaction, with similar health outcomes.
A 2018 study of 603 patients with neck or back pain found people who chose a PT first had lower costs over the next year and improved about as much as people referred by a doctor.
A study in the journal Physical Therapy found lower short-term low back pain costs in states with unrestricted access than in states with limits like California's.
In the military health system, early PT that followed guidelines was linked to 60% lower low back pain costs.
An older 2014 review found the same pattern of fewer visits, less imaging, and higher satisfaction. The 2021 low back pain clinical practice guideline from the Academy of Orthopaedic Physical Therapy recommends active treatment such as exercise and education, delivered by a physical therapist.
Most of these studies looked at adults with back and neck pain. Other conditions are less studied, and after surgery your surgeon's orders usually guide therapy.
Did AB 2497 change the direct access rules in 2026?
No. The rules above are still the law as of October 2026. Assembly Bill 2497 would have removed the direct access notice and limits, but the Assembly refused passage on May 28, 2026 (26 for, 19 against), short of the 41 votes needed. We will update this post if that changes.
How does direct access work with in-home physical therapy?
The same rules apply when your PT comes to your home. At Quad Therapy Inc., the first in-home physical therapy visit starts with the signed notice and a full evaluation. We count visits and days from that visit, and if you need care past the limit, we send your plan of care to your physician or podiatrist early so treatment does not stop.
If your insurance needs a referral, we tell you before the first visit. To prepare, read what to expect at your first physical therapy evaluation. We serve patients in Burbank and across Los Angeles County.
Frequently asked questions
Do I need a prescription for physical therapy in California?
No. You can start with a licensed PT for up to 12 visits or 45 calendar days without one. Your insurance may still require a referral to pay.
Can a physical therapist diagnose me?
No. A PT evaluates and treats movement problems but may not diagnose a disease. If your PT finds signs that need medical testing, the law requires a referral.
Can the doctor's exam for the plan of care be done by telehealth?
Yes. Since January 1, 2023, the physician or podiatrist exam can be in person or by telehealth. The signature on the plan must be dated.
Does Medicare require a referral for physical therapy?
No referral is needed first. For visits to be paid, a physician or qualified practitioner must certify your plan of care within 30 days of the first treatment.
Can my child get school-based PT without a doctor's order?
Yes, when the PT is part of an IEP or IFSP and the child has no medical diagnosis. The 12-visit, 45-day limit does not apply then.
About Quad Therapy
Quad Therapy Inc. is a therapy company in Burbank, California, founded by a licensed physical therapist. We go to the patient. Our licensed therapists provide [SERVICES] in the home, and we staff clinics, schools, and facilities with qualified therapists. Every service is provided by a clinician licensed by the matching California board and stays within that board's scope of practice. To schedule a visit or ask about staffing, call (855) 313-3201 or visit quadtherapy.com. Our office is at 455 N Moss St, Suite 102, Burbank, CA 91502.
Next step: if you have pain or trouble moving and want to start without a referral, book an in-home evaluation. We will check your insurance before the first visit. Clinics and schools that need therapists can see our staffing services.
This article is for education. It is not medical advice. Talk with a licensed clinician about your situation.
Sources
California Business and Professions Code § 2620.1, Direct physical therapy treatment services (amended by SB 1438, effective January 1, 2023). law.justia.com
AB 2423 (2018), Physical therapists: direct access to services: plan of care approval (IEP and IFSP exemption). legiscan.com
AB 2497 (2026), Physical therapists. Status: refused passage, Assembly floor, May 28, 2026. CalMatters Digital Democracy
Demont A, Bourmaud A, Kechichian A, Desmeules F. The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review. Disabil Rehabil. 2021;43(12):1637-1648. Systematic review. PEDro
Gallotti M, Campagnola B, Cocchieri A, Mourad F, Heick JD, Maselli F. Effectiveness and consequences of direct access in physiotherapy: a systematic review. J Clin Med. 2023;12(18):5832. Systematic review. PMC
Denninger TR, et al. The influence of patient choice of first provider on costs and outcomes: analysis from a physical therapy patient registry. J Orthop Sports Phys Ther. 2018;48(2):63-71. Cohort study. Duke Scholars
Unrestricted direct access to physical therapist services is associated with lower health care utilization and costs in patients with new-onset low back pain. Phys Ther. PMID 31665461. Cohort study. PubMed
George SZ, Fritz JM, Silfies SP, et al. Interventions for the management of acute and chronic low back pain: revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60. Clinical practice guideline. PubMed
Maselli F, et al. Standardized definition of red flags in musculoskeletal care: a comprehensive review of clinical practice guidelines. Medicina. 2025;61(6):1002. Review of guidelines. PMC
Childs JD, Fritz JM, Wu SS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res. 2015;15:150. Cohort study. BMC
Ojha HA, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: a systematic review. Phys Ther. 2014;94(1):14-30. Systematic review. PEDro
Centers for Medicare & Medicaid Services. Complying with outpatient rehabilitation therapy documentation requirements (MLN905365). cms.gov
American Physical Therapy Association. Direct access and Medicare. apta.org