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General Office Practice Protocols/FAQs
Physical therapists in California need a diagnosis from a licensed health care professional who is authorized by his/her license to diagnose (i.e. physicians, dentists, podiatrists, chiropractors, etc.). Physical therapists are not allowed to diagnose. Although a physical therapist may perform an evaluation without a diagnosis, one is required prior to the physical therapist providing any physical therapy treatment. A referral is not required by the State of California.
Once you have a diagnosis, the physical therapist will evaluate your condition, discuss the evaluation with you, and implement a personalized treatment plan and therapy goals.
If a third party payor (i.e. health insurance) will be billed for your physical therapy services, please follow the policy and procedures of that agency. For example, the third party payor may also require you to have a referral along with the diagnosis from a licensed professional who is authorized to diagnose in order for your services to be reimbursed. The Physical Therapy Board of California does not regulate insurance companies or billing. Therefore, it is your responsibility to understand how your services will be paid.
You should only be billed for services provided. If you feel there was double billing or you have concern that you were billed for services that were not provided, submit a complaint form or file your complaint through the DCA BreEZe Online Services and it will be reviewed. However, if you are being charged for services that are not covered by your insurance or for services that were beyond what is covered by your insurance, the PTBC does not have jurisdiction. It is ultimately the patient's responsibility to know what their insurance covers.
Who is ultimately responsible for my care, the physical therapist, physical therapist assistant, or physical therapist aide?
Physical therapists are responsible for the care provided by the physical therapist assistant and/or the physical therapy aide under their supervision. The supervising physical therapist delegates and should be monitoring and supervising the care provided to their patients by the physical therapist assistant and/or aide.
What can I do if I am receiving physical therapy in my home and the physical therapist is billing for services not provided?
You should only be billed for services provided. If you feel there was double billing or you do have concern that you were billed for services that were not provided, submit a complaint form or file your complaint through the DCA BreEZe Online Services and it will be reviewed. However, if you are being charged for services that are not covered by your insurance or for services that were beyond your insurance coverage, the PTBC does not have jurisdiction.
What if I am seen only by a physical therapist assistant or physical therapy aide is this common practice?
The physical therapist must initially evaluate each patient and formulate a treatment program goals and plan based on the evaluation prior to the physical therapist assistant or aide providing any treatment to the patient. The physical therapist must first evaluate your condition in order to delegate and to determine what elements of the treatment plan may be assigned to a physical therapist assistant or physical therapy aide.
When services are provided by a physical therapy aide, the supervising physical therapist shall at some point during the treatment day, provide direct service to the patient as treatment for the patient's condition, or to further evaluate and monitor the patient's progress, and shall correspondingly document the patient's record.
Are the individuals providing physical therapy care required to identify themselves as a physical therapist, physical therapist assistant, and/or physical therapy aide?
Physical therapists and physical therapist assistants must disclose, while working, his or her name and practitioner's license status, as granted by this state, on a name tag in at least an 18-point type. A physical therapist or physical therapist assistant in a practice or an office, whose license is prominently displayed in the office, may opt not to wear a name tag.
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