California Direct Access Physical Therapy: 45-Day and 12-Visit Cap

California lets you see a physical therapist without a doctor’s referral. Under Business and Professions Code Section 2620.1, direct access physical therapy in California means you can walk into a licensed PT’s office, be evaluated, and start treatment the same day. The catch is twofold: care under direct access is capped at 45 calendar days or 12 visits, whichever comes first, and no insurer is required to pay for it just because the law permits it.¹

What a Physical Therapist Can Do Without a Referral

A licensed physical therapist can evaluate and treat you without a prior medical diagnosis, provided the care falls within the scope of physical therapy practice. That scope includes hands-on rehabilitation, therapeutic exercise, and interventions using heat, light, water, electricity, sound, and massage. It does not include diagnosing disease or using X-rays for diagnostic purposes.²

The therapist carries the responsibility of confirming that your condition is one physical therapy can appropriately address. If your symptoms point to something outside that scope, or you are not making measurable progress, they must refer you to a physician, osteopath, dentist, podiatrist, or chiropractor.¹

Before any treatment begins, the therapist must give you a written disclosure, delivered both orally and in writing, printed in at least 14-point type, and signed by you. The notice has to state that you are receiving direct physical therapy treatment services from someone licensed by the Physical Therapy Board of California. This is a legal prerequisite, not a formality. If you are not asked to sign it at your first visit, the therapist is out of compliance with the direct access statute.³

The therapist must also disclose any financial interest they have in treating you, and with your written permission, notify your existing physician that you are receiving direct access care.

The 45-Day and 12-Visit Cap

Direct access treatment is limited to 45 calendar days or 12 visits, whichever comes first. The clock starts on your first visit, and the physical therapist is required to track both. Once you hit either threshold, treatment must stop unless a physician or podiatrist authorizes continued care.¹

Two situations are exempt. Wellness services, meaning general fitness and physical maintenance rather than treatment for an injury or condition, are not subject to the cap. Physical therapy delivered under an individualized education plan or individualized family service plan through the federal Individuals with Disabilities Education Act is also exempt when the patient has no medical diagnosis.

Continuing Care After the Cap

To keep receiving physical therapy after you hit 45 days or 12 visits, a physician (MD or DO) or a podiatrist has to sign and date your plan of care. That signature means they have reviewed and approved the plan and have examined your condition in person or via telehealth, with any additional testing they consider appropriate.¹

Note who is not on that list. Dentists and chiropractors appear in the statute as appropriate referral targets when your condition falls outside physical therapy’s scope, but they cannot sign off on continued direct access treatment. Only a physician or podiatrist can.

Will Your Insurance Pay?

The statute spells out that no health care service plan, insurer, workers’ compensation plan, employer, or state program is required to cover direct access physical therapy.³ Patients commonly assume that because California allows direct access, their plan will reimburse. Whether it does comes down to the terms of your specific policy.

Private Insurance

HMO plans generally require a referral from your primary care physician before they will authorize payment for physical therapy. Skip the referral and you may owe the full cost of the visits. PPO plans are more likely to cover direct access, but many still require pre-authorization. Call your insurer before your first appointment. Ask whether PT visits initiated without a physician referral are covered, what your copay or coinsurance will be, and whether pre-authorization is needed.

Medi-Cal

Medi-Cal covers physical therapy only when it is ordered by a physician, dentist, or podiatrist. Direct access without a prescription from one of these providers does not qualify for reimbursement.⁴ If you are a Medi-Cal beneficiary, get a written prescription before starting treatment or expect to pay out of pocket.

Medicare

Medicare operates under federal rules regardless of California’s direct access law. A physician or qualifying non-physician practitioner (nurse practitioner, physician assistant, or clinical nurse specialist) must certify your plan of care, with recertification at least every 90 days.⁵ A rule change effective January 1, 2025 allows the therapist to establish the plan without a separate physician signature on it if your medical record already contains a written order or referral and the therapist delivers the plan to the physician within 30 days of the initial evaluation. Recertifications still need a physician or non-physician practitioner signature.

Workers’ Compensation

Workers’ comp plans are named in the statute as payers that do not have to cover direct access treatment.³ Workplace injury claims in California run through a separate authorization process tied to your employer’s claim. Get a physician’s referral before starting physical therapy for a work injury, or your visits may not be reimbursed.

Paying Out of Pocket

If coverage falls through, a single physical therapy session typically runs between $75 and $250 nationally, with California prices tending toward the upper end, especially in metropolitan areas. The initial evaluation often costs more than follow-up visits. Ask the clinic for their self-pay rates before your first appointment, and ask whether they offer a reduced rate for patients paying without insurance.

If the Cap Passes Without a Signature

If you reach 45 days or 12 visits and no physician or podiatrist has signed your plan of care, your physical therapist is legally required to stop treating you. There is no grace period, and the therapist cannot keep providing sessions while waiting on paperwork. Your options are to see a physician who can authorize continued physical therapy, or to restart with a physician referral, which moves you out of the direct access framework entirely and lets treatment continue under the physician’s ongoing order.

1
California Legislative Information. California Code Business and Professions Code 2620.1 – Physical Therapy Direct Access
2
California Legislative Information. California Code BPC 2620
3
California Legislative Information. California Code BPC 2620.1
4
California Department of Health Care Services. Physical Therapy (Phys) – Medi-Cal Providers
5
eCFR. 42 CFR 424.24 – Requirements for Certification and Recertification