Can an outpatient therapy provider balance bill a TRICARE beneficiary? In this article, I will answer the following questions:

TRICARE has updated chapters and sections within their TRICARE Policy Manual. This includes physical therapy, occupational therapy, and speech therapy sections. In addition, TRICARE updated the physical therapist assistant and occupational therapy assistant sections. To access all the policies, click HERE. Then, click on the policy you want to read. Changes within each policy will be written in red.

The TRICARE West Region Referral Waiver has been extended through June 30, 2025. Click HERE for further details.

The Defense Health Agency has waived the requirement to obtain pre-authorization for referrals to outpatient specialty care for TRICARE Prime enrollees in the West region. This was done due to issues in the West Region of switching from Humana Military or Health Net Federal Services to TRIWEST as the new West Regional contractor effective January 1, 2025. This waiver can impact outpatient physical, occupational, and speech therapy services. To access the detailed information regarding this waiver, such as effective dates of the waiver, please log into your account and click

In this article, I will answer the following questions regarding TRICARE and the upcoming changes that go into effect on January 1, 2025:

In this article, I will answer the following questions regarding TRICARE and upcoming changes:

I am often asked if TRICARE and CHAMPVA are the same. In this article, I will answer the following questions concerning these 2 programs:

The Centers for Medicare and Medicaid Services (CMS) implemented what providers of outpatient therapy call “Medicare’s 8-minute rule” in 2000. There is a misconception that the “8-minute rule” applies automatically to all federal insurance carriers and Medicare Advantage plans. That is actually not true. Each federal insurance carrier and Medicare Advantage plan can determine if they want to apply Medicare’s “8-minute rule” for payment for outpatient therapy services or use the American Medical Associations’ (AMA) substantial portion methodology. In this article, I will provide the answer to TRICARE and do they follow Medicare’s “8-minute rule” or the AMA substantial portion