PT referral for Imaging

(Please refer to the Iowa PT Practice Act for exact language, Chapter 148A)

 Effective Date: July 1^st, 2023

 Key points of legislative change:

· Physical therapists can refer for imaging, including plain radiographs and MRI, when deemed medically necessary/appropriate.

· Imaging is performed and results are interpreted by a qualified health care professional.

· The PT will report results to the primary care provider (PCP) within 7 days of receipt of the results, unless there is no PCP on file, or the interpreting healthcare professional provides the results to the PCP.

What legislation does NOT change:

· PT’s scope of practice to perform, interpret, or bill for imaging services. (PT does NOT perform, interpret, or bill for imaging ordered)

· Prior-authorization requirements of individual patient third party payor. (PT does NOT complete the prior-authorization, but the local imaging center will complete)

The process to begin the referral for imaging from a PT or PT clinic:

Step 1 – Establish relationships with local imaging centers and verify they will accept your referral and are willing to work with payors to determine coverage and prior-authorization requirements. This may include:

· Working within your healthcare organization to initiate policies on ordering imaging.

· Updating your EMR to send the required information to the imaging center upon referral.

· Educating your local providers and healthcare system of the change to the practice act in Iowa.

 Step 2 – Before imaging, educate patients on questions about insurance coverage to ask the imaging center. Reinforce with the patient that billing for imaging will occur through the imaging center, not the PT office.

· Is prior-authorization required based on their insurance coverage?

· Does the imaging center have their needed insurance information?

 Step 3 – Adhere to APTA professional code of ethics and be accountable to judge when a patient is appropriate for imaging referral.

 Step 4 – Make the referral.

· If the patient is appropriate for referral and the imaging center and patient insurance accepts a referral from a physical therapist, proceed with making the referral to the imaging center.

· If the imaging center or patient insurance does not accept the referral, then refer the patient back to the PCP requesting imaging to clear the patient for appropriate progression of care with physical therapy.

 Step 5 – If the referral occurs, communicate results back to PCP within 7 days of receipt, unless the patient does not have PCP or health professional performing and interpreting previously provided results to PCP.

Other Supporting Information:

• Academy of Orthopaedic Physical Therapy Diagnostic Referral for Imaging: Clinical Decision Resource course: https://www.orthopt.org/course/mli-01-diagnostic-referral-for-imaging-clinical-decision
• Helpful Infographics