One of the most common things I hear from new patients at Solas is some version of: "I didn't know I could just come straight to you." That surprise tells me a lot about how misunderstood direct access physical therapy still is — even though Texas has allowed it for years. If you're dealing with pain, a nagging injury, or a movement problem right now, you don't have to wait weeks for a doctor's appointment just to get a referral to see me. You can book directly and we can start solving the problem today.
Direct access means you can see a licensed physical therapist without a physician referral. Texas has allowed some form of direct access for years, but as of September 1, 2025, HB 4099 significantly expanded that right. You can now walk into Solas, schedule an evaluation, and begin treatment — no primary care visit required, no waiting for a referral to process, no extra copay to a doctor who will simply tell you to see a PT anyway.
Under current Texas law, a physical therapist can evaluate and treat you for up to 30 consecutive calendar days without a physician referral. That's a substantial improvement over the previous law, HB 29, which capped direct access at just 10 days for standard-licensed PTs — and 15 days for those with a doctoral degree, residency, or fellowship training. As a Doctor of Physical Therapy, I fell into that 15-day tier, and even then, the window was often nearly exhausted before a complete course of care could get underway. Thirty consecutive calendar days of focused, one-on-one treatment is, for the vast majority of acute injuries and musculoskeletal conditions, more than enough to fully resolve the problem or carry you well into recovery.
There are a couple of things worth knowing upfront. First, to offer direct access in Texas, a physical therapist must have been licensed for at least one year and carry professional liability insurance — requirements designed to ensure patients are in qualified hands. Second, if your condition genuinely requires care beyond the 30-day window, a referral from a qualified healthcare practitioner is required to continue. And third, even though Texas state law allows direct access, some insurance plans — including Medicare and certain private plans — may still require a physician referral for reimbursement purposes. At Solas, we're a cash-based practice, so that insurance restriction simply doesn't apply to our patients. No referral hoops, no preauthorization delays.
If your condition requires continued care beyond 30 days, getting a referral is easier than you might think. We partner directly with Solas Health & Wellness, where Celeste Cisneros, NP can provide a referral quickly and conveniently — often without the weeks-long wait of a traditional primary care appointment. It's a seamless extension of the same care team.
"In Texas you have the legal right to start physical therapy directly — no referral, no waiting room, no runaround. At Solas, we use that to your advantage. And if you ever need a referral to continue beyond 30 days, our NP partner Celeste Cisneros is right there with you."
The confusion comes from insurance. Most insurance plans — particularly Medicare — do require a physician referral before they'll cover physical therapy. So if you've always used insurance for PT, you've always needed that referral step, and it feels mandatory. But at Solas, we're a cash-based physical therapy clinic, which means we work outside the insurance system entirely. No referral needed. No preauthorization. No insurance hoops to jump through on either side.
This model gives us something that insurance-based corporate clinics can't offer: complete flexibility to treat you based on what you actually need, not what your insurance plan will approve.
Think about the typical path most El Paso residents take when something hurts:
With direct access at Solas, you call or book online, come in within days, and we start the actual work immediately. For acute injuries especially, this matters enormously. The research is clear: earlier physical therapy intervention leads to faster recovery, fewer visits overall, and lower total cost of care. Waiting weeks to begin treatment allows compensatory movement patterns to develop, secondary muscles to tighten, and the problem to become more complex than it needed to be.
When I say Solas is different from the corporate PT chains in El Paso, the most important difference isn't just the referral question — it's what happens once you're in the door. At large-volume clinics, you might spend 15 minutes with a therapist and the rest of the session with an aide doing exercises in a crowded gym. At Solas, every session is one-on-one with me, Dr. Andrew Cisneros, for the full appointment.
That means I'm performing hands-on manual therapy, watching your movement, adjusting the treatment based on how you're responding, and having an actual conversation about your progress. I see a limited number of patients per day specifically so I can give each person my complete attention. You're not a number in a schedule — you're the only person I'm thinking about during your session.
Direct access works well for a broad range of musculoskeletal conditions. At Solas I commonly see patients without referrals for:
There are some situations where I may recommend you see a provider first — if I suspect something that requires imaging, if your symptoms suggest a non-musculoskeletal origin, or if you need care beyond the 30-day direct access window. In those cases, Solas Health & Wellness and Celeste Cisneros, NP are right here to provide that bridge — keeping your care coordinated within the same trusted team rather than sending you off to a stranger. But for most people who come through my door, direct access is all you need to get started and get better.
This is the question I hear most often, and the honest answer is: it depends on your situation, but for many patients it's actually cheaper. Here's why.
With insurance-based PT, you pay a copay every visit — often $30–60 — plus potentially a deductible. You might be approved for 6 visits when you actually need 10, creating a coverage gap. You're also paying for that initial doctor's visit just to get the referral. Add it up and the actual out-of-pocket cost is frequently close to what you'd pay at Solas, often with fewer total visits because the one-on-one attention allows faster progress.
At Solas, our pricing is transparent and straightforward. You know exactly what each session costs before you come in. No surprise bills. No EOBs to decipher three months later. View our current pricing here.
Fyzical, Spectrum, and other large PT chains in El Paso serve a certain type of patient well — people who need a high-volume, insurance-covered option near their home. There's a place for that. But if you're someone who wants to actually understand what's causing your pain, who wants to work with the same therapist every session, and who wants a treatment plan built specifically for your body and your goals — that's what Solas is built for.
I built this practice on the conviction that physical therapy should feel like a genuine partnership between a skilled clinician and a motivated patient. No rushed appointments. No passing you off to an aide. No cookie-cutter programs. Just expert, attentive, hands-on care — every time you walk through the door.
Booking is simple. You don't need anything from your doctor, no referral forms, no pre-authorization paperwork. Just reach out directly:
Your first appointment is a full evaluation — I'll assess your movement, identify what's driving your symptoms, and give you a clear picture of what treatment will look like and how long it should take. No surprises, no vague timelines.
Ready to skip the referral and start getting better?
Book your evaluation directly with Dr. Cisneros — no physician visit required.
Direct access physical therapy means you can see a licensed physical therapist without a physician's referral. Texas law allows patients to evaluate and receive treatment from a PT directly, without needing to visit a doctor first. At Solas PT in El Paso, Dr. Cisneros sees patients under direct access — you call, book, and start treatment, often within the same week.
No. Texas is a direct access state. You can see a physical therapist without a doctor's referral for evaluation and treatment. Some insurance plans still require a referral for coverage — but at Solas PT, which is cash-based, no referral is needed under any circumstances.
Texas law allows physical therapists to treat patients for up to 30 days under direct access before requiring physician communication if treatment is ongoing. In practice, most conditions are significantly improved or resolved within this window. If ongoing care beyond 30 days is needed, Dr. Cisneros will coordinate with your physician as appropriate.
Most musculoskeletal conditions are appropriate for direct access PT, including back pain, neck pain, shoulder injuries, knee pain, sciatica, hip pain, sports injuries, rotator cuff problems, headaches of musculoskeletal origin, and post-surgical rehabilitation. Conditions that may require physician evaluation first include suspected fractures, infections, tumors, or systemic conditions with neurological involvement.
Often not — and sometimes it is cheaper. Once you account for deductibles, co-pays, and co-insurance, insurance-based PT visits commonly cost patients $50–120 out-of-pocket per session anyway. Cash-based PT at Solas PT is transparent — you know the price before your first visit, sessions are longer and fully one-on-one, and there are no surprise bills. HSA and FSA funds can also be used.