Physical Therapy Prescription

Original Editor - User Name Top Contributors - Ruchi Desai, Jeremy Bryan and Vidya Acharya

Introduction

A physical therapy prescription, sometimes called an order or a referral, is a written or electronic document, from a specific medical professional, authorizing the the need for a physical therapy evaluation and or treatment.

Physical therapy care can currently be received in many areas via direct access, without the need for a physical therapy prescription. However, local regulations as well as insurance requirements still often require a physical therapy prescription under certain circumstances.

Components of a Physical Therapy Prescription

Prescription formats can vary widely, but usually include the following information:

• Name and birthday of patient
• One or more International Classification of Diseases diagnosis code(s), associated with the need for physical therapy treatment
• A written explanation of the chief complaint or reason for the need for physical therapy intervention
• Recommended frequency of treatment
• Authorized length of the plan of care
• Name, signature, and license or identification number of medical practitioner authorizing care
• Name of clinic or institution medical practitioner is associated with, if applicable
• Contact information of medical practitioner

Summary Components of a Physical Therapy Prescription

Diagnosis is to be treated with physical therapy; proper coding should be used to allow for accurate insurance billing and reimbursement. Frequency and duration of therapy (e.g., daily for five days, three times per week for four weeks) depending on the condition being treated. Specific protocols or treatments that the physician wants the therapist to use. Safety precautions (e.g., joint range-of-motion limitations, weight-bearing limitations, illnesses that impact therapy decisions) Physician signature and date are required for a therapist to perform the requested services

Table 2 shows general algorithm for prescribing physical therapy interventions to treat musculoskeletal injury . however individual prescriptions are based on the patient’s specific condition and comorbidities and on the availability of modalities.

	Acute (< 72 hours)
Goals	Decrease edema Decrease pain Improve healing Increase range of motion	Improve flexibility Improve functional mobility Increase muscle tone	Functional improve­ment of activities of daily living Restore normal tissue length
Modality	cold application, electrical stimulation, pulsed ultrasound
Exercise	isometric, gentle active range of motion	Exercise: isotonic, active range of motion, stretching	Manual therapy: massage, joint mobilization
Manual therapy	gentle massage	massage, joint mobilization	myofascial release
Intensity	Daily for five days	Three times per week for two weeks	Twice per week for four weeks

Sometimes a prescription will only be for a physical therapy evaluation, but no treatment. In this case, the physical therapy evaluation will be performed and the documentation will be sent back to the medical professional who wrote the prescription, who will then decide whether or not to write a new prescription for further physical therapy treatment.

Referring Practitioners

In most cases, in order for a physical therapy prescription of be accepted by a Physical Therapist, it must come from one of a few types of medical professionals. Generally, acceptable medical professionals are included below. However, local regulations may include some, all, or more than those listed.

• Physicians
• Osteopathic Physicians
• Surgeons
• Podiatrists
• Physician Assistants
• Advanced Registered Nurse Practitioners
• Dentists
• Chiropractors

Direct Access

Direct access means being able to receive physical therapy services without a physical therapy prescription.

According to Piscitelli, Furmanek, Meroni, De Caro, and Pellicciari, a 2012 survey indicated that direct access to physical therapy services were available in 40 different countries.

In the United States, according to the American Physical Therapy Association, as of February of 2021, there were 20 states that allowed direct access with no parameters or restrictions, 27 states, along with the District of Columbia and the US Virgin Islands, that allowed direct access with some form of parameters or restrictions, and three states that allowed direct access only under specific circumstances.