TriCare and Use of Assistants

February 20, 2017
Rick Gawenda

I receive many questions regarding TriCare and do they reimburse for services provided by a physical therapist assistant or an occupational therapy assistant? Perhaps, we should be asking if TriCare knowingly reimburses for services provided by a physical therapist assistant or an occupational therapy assistant?

According to the American Physical Therapy Association as well as discussions with expert consultants in the area of outpatient therapy, TriCare does

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  1. What about our DPT students who are treating under the supervision of a licensed PT who is in the same room as them treating another patient?

  2. Do you have a suggestion on how a PTPP could better a advocate for recognition of the PTA in assisting with the delivery of PT services?
    I live adjacent to the largest Army post and we are inundated with referrals d/t the post being unable to serve its spouses, family members and retires. Like everywhere in America – there aren’t enough PT’s available.

    1. Tell your stories to APTA and your elected officials. Better yet, have your patient’s tell their stories to their elected government officials.

  3. We have occasion where Tricare is the patient’s secondary insurance. At times, the PT may delegate care of the patient to a PTA before it is known that Tricare is secondary. Should we avoid delegating those patient’s to PTAs as well?

  4. Can a patient still see a PTA at a cash based practice as long as they are informed that they won’t be reimbursed for services provided by the PTA? Or is it illegal for a Tricare patient to see a PTA all together?

    1. You would need to read your contract and the TriCare manual. I would also recommend you contact APTA regarding your question. TriCare does cover PT services if provided by a PT.

  5. Great info. We were told on a Tricare webinar a few years ago that PTAs/OTAs could treat in inpatient settings because there is no way to designate whether the service was provided by a therapist or an assistant on a UB04/facility claim. We are a SNF/rehab agency setting, but have always tried to avoid using assistants if Tricare is involved in any way. However, would like to have your thoughts on what they told us re: the UB04.

  6. If Tricare is secondary – as stated above the PTA still can not see the pt……… Can we choose to bill the primary insurance and not bill Tricare for the secondary portion?

      1. With the CO/CQ modifiers, what would happen if a PTA bills a Medicare primary, Tricare Secondary patient? Would Tricare deny their portion of the claim or would the whole claim be denied?

        1. A PTA can’t treat a TRICARE patient whether TRICARE is primary or secondary and have that claim submitted to TRICARE for any payment.

  7. We contacted our Tricare representative here in Virginia and re-verified that Tricare DOES NOT reimburse for physical therapy services performed by a PTA and is considered illegal to do so.

  8. Can you comment on if you think this would also pertain to skilled days in the SNF setting?

    1. I would recommend you contact APTA and AOTA regarding the use of assistants with TriCare patients in the SNF Part A setting.

    1. If you are submitting a claim to TriCare, then the PTA and OTA rules and regulations would apply.

  9. Is a PT able to utilize a Tech in the treatment of a Tricare patient? If so then why can’t a PT supervise a PTA as if they were a tech?