The state of Illinois no longer requires a prescription prior to seeking physical therapist care.
A physician's diagnosis is no longer required for evaluation and treatment by a physical therapist. However, your individual insurance plan may have unique requirements, such as physician certification of medical necessity or a physician signature on the plan of care. We will help you determine some of your insurance company's requirements, but you may also contact them directly for more information.
Here is some guidance directly accessing physical therapy services under the Illinois law signed August 16, 2018.
The Illinois Physical Therapy Practice Act allows patients to seek physical therapy without a prescription from a health care professional. Until 2018, Illinois residents were required to have a referral from a physician, dentist, podiatric physician, advanced practice registered nurse or physician assistant. As of August 16, 2018, patients in Illinois may directly seek care from a physical therapist for evaluation and treatment.
Consumers should note that the Illinois law gives health plans the discretion to allow direct access to physical therapy, but it is not required. Limitations remain for some health care policies, including Medicare. There are also provisions that physical therapists and patients must follow. It is important for patients to consider their healthcare benefits as well as their health plans’ medical policy.
- Direct Access is typically available in Illinois with the following health plans: Blue Cross Blue Shield of Illinois, personal injury coverage, auto insurance coverage.
- At this time, a prescription for physical therapist care or signature on the plan of care may still be needed for patients with Aetna, United Healthcare, Tricare, Cigna and worker’s compensation coverage.
- Medicare continues to require a signed plan of care as a condition of payment and in nearly all instances, a prescription from a licensed physician, physician assistant or nurse practitioner.
To assure the highest level of accuracy for individual cases, patients should contact their health care plan to confirm whether a referral is needed.
Patients should be aware that the law requires physical therapists to report to the patients’ treating health care professional within five business days after the first visit for an injury or ailment. The patient will also be referred to a health care 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.
We are specialists in the practice of physical therapy. If you are experiencing pain, simply call and make an appointment. A prescription is no longer required and you start your journey back to health immediately.
- PhysioPartners and the Renaissance CranioFacial Group provide leading edge physical therapist care, bringing techniques from around the world to our practice and patients. We have created coursework to develop the profession to Illinois. In 2009, Jennifer Hobson advocated for dry needling in Illinois and was instrumental in its approval.
- We work with the top doctors and specialists in their field. Whenever you have pain or injury, are planning treatment or need an evaluation, you therapist will work seamlessly with your healthcare team to return you to health.