TRICARE and Assistants

December 22, 2018
Rick Gawenda

The Department of Defense has released the long awaited proposed rule where the Department of Defense would add physical therapist assistants (PTA’s) and occupational therapy assistants (OTA’s) as TRICARE authorized providers. In summary, this proposed rule would add PTA’s and OTA’s as authorized TRICARE providers under the supervision of a TRICARE-authorized physical therapist or occupational therapist in accordance with Medicare’s rules for supervision and qualification when billed by under the supervising therapist’s national provider identification number.

Regarding supervision requirements, TRICARE is proposing the same supervision requirements for PTA’s and OTA’s

The content here is for members only log in here or sign up.

All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  1. Does this also apply in outpatient hospital settings under a group NPI# or just private practice?

    1. This applies to all settings. Currently, PTAs and OTAs can’t treat TRICARE patients and have their services billed to TRICARE in any setting.

  2. I’m assuming the restriction on PTA/OTA applies when Tricare is a secondary?

    How does this apply with inpatient SNF? For example, Medicare A covers the first 20 days at 100%, and then starting on day 21, Medicare requires a copay, that Tricare covers completely. Can PTA/OTAs be utilized until day 21, when Tricare starts paying the co-pay?

    1. My opinion is not to have PTAs and OTAs treat any TRICARE patients where TRICARE is being billed either as the primary or secondary insurance.

      1. What is the reason that SLP Assistants won’t be added as an authorized Tricare provider. It isn’t in the scope of practice to work with swallowing disorders. Other than that, they can treat articulation and language development. Is there a valid reason Tricare will not allow them to treat patients. Just trying to understand.

        1. I can’t speak on behalf of TRICARE, but my opinion is due to the fact that the Medicare program and majority of commercial insurance companies do not pay for therapy services provided by a SLPA.

  3. It’s my understanding that PTAs/OTAs can not treat Tricare patients even with a co-sign from the PT or OT every time they treat the patient. Is this correct?