By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults


I bet if I asked if you’ve ever heard of the term “Direct Access” you’d likely say no.  Even if you did,  you’d likely not know exactly what it meant.

Don’t feel bad – you’re not alone!

As a physical therapist with nearly 30 years of experience, I’ve personally witnessed many changes in laws governing the practice of outpatient physical therapy.  Some of these changes are state specific and some affect things on a more national level.  Many of these changes have profound implications relating to the quality and integrity of the profession while others impact consumers’ access to physical therapy care on an outpatient basis (i.e., when you go to an outpatient PT practice, either located within a hospital or, more commonly, when you go to an outpatient clinic at a separate physical location).

Some facilities are owned by the hospital system, while others are owned by physician groups or investors, and some are owned privately by independent physical therapists or groups of PT clinicians.  Direct access affects all of these.

For the longest time, you needed to be referred to a physical therapist by your doctor or dentist. Then that evolved to include nurse practitioners and physician assistants (i.e., “physician extenders”).  Some states limit whether chiropractors may directly refer their clients to a physical therapist (but they should have a conversation with them, if indicated, about how PT could help them and suggest they investigate on their own or via their primary care physician).

However, due to the importance of physical therapy as it relates to optimizing independence and recovering fully from an accident like a fall or sports related injury, or after a stroke or joint replacement, or from a newly diagnosed progressive condition like Parkinson’s Disease or an acute flare of Multiple Sclerosis, access to physical therapy has transformed from the referral only requirement to the Direct Access allowance.

DIRECT ACCESS to Physical Therapy is What’s Up!!!


By the way, physical therapy doesn’t always have to be “progress oriented” and another recent transformational change affecting physical therapy was a formal clarification during the Obama Administration specifying that PT is appropriate to manage chronic conditions that, in the absence of skilled PT services, would likely cause a progressive decline in functional independence or quality of life.  Thus, outpatient PT is very appropriate in cases involving chronic conditions when “progress” may be less likely.  Examples of this include weakness on one side of the body remaining after an older stroke or when battling progressive conditions like Ankylosing Spondylitis, Parkinson’s Disease or Multiple Sclerosis.

Here’s what you need to know about your rights to access outpatient physical therapy in South Carolina:
  • South Carolina adopted Direct Access with special provisions in 1998. This means you do not need a referral to be evaluated by a PT or to start receiving treatment in PT;
  • In the absence of a valid referral, your PT must refer you to a licensed medical doctor or dentist if providing PT services to you beyond 30 days after your initial evaluation;
  • Your PT must refer you to a licensed medical doctor or dentist immediately if your condition is beyond the scope of Physical Therapy.


Every state has some form of direct access these days. 

  • Some states are much more restricted than others, so if you’re reading this and are not from SC, you can find what your state allows by reviewing the American Physical Therapy Association’s (APTA) summary of direct access by state (Direct Access by State: found online (2/20/2018) at:


  • Should you feel you might benefit from outpatient physical therapy care, you can still ask your doctor for a referral, but know that it’s not mandatory unless required by your insurance plan.  You can go to any outpatient PT that accepts Direct Access cases – it’s YOUR choice – so choose wisely and get started on the path to FEELING better, MOVING better and LIVING better!

Getting back into fitness routine


Summerville Physical Therapy & Balance Rehabilitation for Adults

679 Orangeburg Road | Suite D | Summerville, SC 29483|  843-209-6375