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

QuestionCan therapy students treat TRICARE beneficiaries for outpatient physical, occupational and/or speech therapy services and have those services billed to the TRICARE program for reimbursement? Answer I hope you found this article helpful and informative and you now have a good understanding of therapy students treating TRICARE beneficiaries. Thank you for being a Gold Member!

TRICARE has provided updated information regarding their low back pain (LBP) and physical therapy demonstration scheduled to begin on January 1, 2021. Updated information includes the following: Demonstration goals and evaluation Policy and beneficiary eligibility ICD-10-CM Diagnosis codes applicable to demonstration Exclusions to the demonstration Under Policy and Beneficiary Eligibility, TRICARE states the following: I hope you found this article helpful. Thank you for being a Gold Member!

As more and more practices choose not to enroll with commercial insurance carriers, including Medicare Advantage programs, a common question I am asked is must I enroll with TRICARE to be able to provide outpatient therapy services to TRICARE beneficiaries. In this article, I will provide the answers (with resources) to some of the more common questions I receive. QuestionMust I enroll with TRICARE to be able to provide outpatient therapy services to TRICARE beneficiaries? Answer QuestionWhat does TRICARE mean when they state “any TRICARE-authorized provider who hasn’t joined the network is a non-network provider? Answer QuestionCan a physical therapist

The Director, Defense Health Agency (DHA), has approved the creation of a demonstration to waive cost-sharing for up to three physical therapy (PT) visits for TRICARE beneficiaries with low back pain (LBP). Dates of the DemonstrationThis demonstration project will be effective Demonstration StatesThe following states were selected as demonstration states: Description of the Demonstration Provider Requirements under the Demonstration Purpose of the Demonstration Other Relevant Details To read all about the demonstration project, click I hope you found this article informative and helpful. Thank you for being a Gold Member!

Health Net Federal Services, LLC (HNFS), who is the TRICARE West Region Contractor, has provided an update on what place of service (POS) code to use on the 1500-claim form when providing a telehealth visit. HNFS is now asking providers to use the POS that represents In addition, HNFS has provided an update on reimbursement and resubmission of claims. By using an incorrect POS code, the provider may have been or will be reimbursed at the facility CHAMPUS Maximum Allowable Charge (CMAC) rate, rather than a non-facility CMAC. If you provided telemedicine services from a non-facility setting, you may submit

TRICARE updated their physical therapy policy manual on February 26, 2020. Updates to this manual include Transcutaneous Electrical Nerve Stimulation (TENS) and Dry Needling. In addition, TRICARE lists more than 16 interventions and services that are excluded from payment in this policy. If you treat TRICARE patients, this is a must-read policy. To access the policy, click