Direct Access, Referral Requirements, and Care Without a Physician Referral
Direct access items test whether a patient can be treated in Georgia without a physician referral and, if so, for how long and with what documentation. This is one of the few areas where specific numbers control the answer, so precision matters more than general principle.
The direct-access window
Georgia permits a physical therapist to examine, evaluate, and treat a patient without a referral for a limited period - commonly summarized as eight visits or 21 days, whichever comes first. Once either limit is reached, continued treatment requires a referral from an authorized practitioner, such as a physician, dentist, podiatrist, or chiropractor. The referral must be documented in the record along with the date it was received.
Conditions on treating without a referral
- The PT must stay within the scope of physical therapy and refer out promptly when findings suggest disease or a condition requiring medical evaluation.
- Red flags - unexplained weight loss, night pain, fever, progressive neurological deficits, signs of clotting - require referral, not another visit.
- The patient should be advised to inform his or her primary care provider, and communication with that provider should be documented.
- Payers may impose their own referral requirements; the statute sets a floor, not a guarantee of coverage.
Worked example
A patient self-refers with knee pain after a fall. The PT evaluates, treats, and schedules follow-up. The patient is seen on day 1, 8, 15, 22, and 29. By day 22 the 21-day limit has passed, and by the fifth visit the eight-visit limit has also passed, so a referral must be obtained before treatment continues. If the patient's physician sends a referral on day 18, the PT documents it and the statutory window no longer limits care.
Traps
Counting only visits and forgetting the calendar; counting only days and forgetting visits; accepting a referral from someone not authorized to refer; relying on a verbal referral that never reaches the chart; treating beyond the window while a referral is 'in the mail.'