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

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!