TL;DR: Not always, under Texas law. A physical therapist who meets three conditions may treat you without a referral for up to 30 consecutive calendar days. To keep treating you after that, the therapist needs a referral. When you start without one, you sign a disclosure form. Your health plan is a separate question: some plans want a referral or prior authorization before they pay for physical therapy, and Medicare needs a provider to certify that you need it. Call your plan, or call us, before your first visit.
What Texas law says
The rule is in Texas Occupations Code §453.301. A physical therapist may treat you for an injury or condition without a referral if the therapist:
- has been licensed to practice physical therapy for at least one year;
- has professional liability insurance in at least the amount the Texas Board of Physical Therapy Examiners requires; and
- either holds a doctoral degree in physical therapy from an accredited program or institution, or has completed at least 30 hours of continuing competence activities in differential diagnosis.
A therapist who meets those conditions may treat you without a referral for not more than 30 consecutive calendar days. To continue past that point, the therapist must get a referral from a referring practitioner.
The 30-day limit took effect on September 1, 2025, when House Bill 4099 amended the law. Older articles may describe a shorter limit, so check the date on anything you read.
Who can refer you
The law defines a “referring practitioner” as a qualified licensed health care professional who, within the scope of their license, may refer a person for health care services. The definition names physicians, dentists, chiropractors and podiatrists (§453.001).
The disclosure you sign
If a physical therapist treats you without a referral, you sign a form, prescribed by the state board, acknowledging that:
- physical therapy is not a substitute for a medical diagnosis by a physician;
- physical therapy is not based on radiological imaging;
- a physical therapist cannot diagnose an illness or disease; and
- your health insurance may not cover the physical therapist's services.
That last point is the one that catches people out. State law allowing treatment without a referral does not mean your plan will pay for it.
What your insurance may require
Health plans set their own rules. Some require a referral from your primary care provider before they pay for physical therapy, some require prior authorization, and many limit the number of visits. These rules apply whatever state law allows, so check your plan before you book.
Medicare Part B helps pay for medically necessary outpatient physical therapy. According to Medicare, your doctor or another health care provider, including a nurse practitioner, clinical nurse specialist or physician assistant, must certify that you need it. After the Part B deductible, you pay 20% of the Medicare-approved amount.
When to see a medical provider first
Because a physical therapist cannot diagnose an illness or disease, a new problem that has not been looked at, or one that is getting worse in a way that worries you, is a reason to see a medical provider first. For a medical emergency, call 911 or go to the nearest emergency room.
At Innovare Tx
Physical therapy here is with Rowena Calleja, PT, a Texas-licensed physical therapist, in the same clinic as Charles Ortega, PA-C. We accept Aetna, Blue Cross Blue Shield (in-network), Cigna, Medicare, UnitedHealthcare and federal OWCP claims, among 200+ plans, but not Texas state workers' compensation. Call (214) 233-3094 before your first visit and our team will check your benefits and whether your plan needs a referral. See insurance and billing.
Next step · Decide
Your first physical therapy visit
What the evaluation involves, what to bring, and how insurance and Medicare pay for PT.
How long can a physical therapist treat me without a referral in Texas?
Up to 30 consecutive calendar days, if the therapist meets the conditions in Texas Occupations Code §453.301. After that, the therapist needs a referral to continue.
Will my insurance pay for physical therapy without a referral?
It depends on your plan. The disclosure form you sign for treatment without a referral says your insurance may not cover it. Call your plan, or ask our team to check.
Does Medicare need a referral for physical therapy?
Medicare requires your doctor or another health care provider, such as a nurse practitioner or physician assistant, to certify that you need outpatient physical therapy.
