Current News



Can Therapy Students Treat TRICARE Patients?

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!

Read More

TRICARE Updates LBP and Physical Therapy Demonstration

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!

Read More

Must I Enroll in TRICARE to Treat TRICARE Patients

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

Read More

TRICARE to Initiate LPB Demonstration Project

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!

Read More

TRICARE Place of Service Update for Telemedicine Claims

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

Read More

TRICARE Updates Physical Therapy Policy Manual

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

Read More

TRICARE Implements CQ and CO Modifiers

Effective with dates of service on and after April 16, 2020, TRICARE recognizes physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) as TRICARE-Authorized Providers. On April 22, 2020, TRICARE updated their Policy Manual to include PTAs and OTAs. Highlights of the Policy Manual update include the following: Scope of practice of a PTA and OTA Supervision requirements of the PTA and OTA based on practice setting Reimbursement for services provided by a PTA or OTA Application of the CQ and CO modifier when services are provided in whole or in part by a PTA or OTA, respectively Payment differential

Read More

TRICARE Now Paying for Services Provided By an Assistant

On March 16, 2020, the Department of Defense issued the long awaited Final Rule titled “TRICARE; Addition of Physical Therapist Assistants and Occupational Therapy Assistants as TRICARE-Authorized Providers” with an effective date of April 16, 2020. This means that beginning with dates of services on and after April 16, 2020, a physical therapist assistant (PTA) and occupational therapy assistant (OTA) are now considered a TRICARE-Authorized Provider. I originally wrote about this change in an article I published on March 16, 2020 for my Gold Members. On April 15, 2020, the American Physical Therapy Association (APTA) published an article discussing the

Read More