TRICARE Now Paying for Services Provided By an Assistant

April 20, 2020
Rick Gawenda

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 addition of a PTA as a TRICARE-Authorized Provider. In this article, Kara Gainer, APTA’s Director of Regulatory Affairs states the following: “We’re telling providers that, yes, the change has occurred and that PTAs are eligible for reimbursement for services rendered beginning on April 16, 2020. However, contractors may not yet have made the necessary systems changes,” Gainer said. “It’s important that providers find out whether their contractors are ready to process the claims and if any new coding requirements are being applied to this change.”

Click HERE to read this article from APTA.

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  1. Do you know if this will apply to assistant services billed on an institutional UB04 claim form?

  2. My understanding is that PTA’s and OTA’s could not provide services to patients with Veteran’s Affairs or Champ VA insurances. Is this true or did it change with the Tricare update?


    1. VA and TRICARE are not the same and the TRICARE ruling does not impact VA. I’m not aware of any rules or regulations with the VA of not allowing PTAs and OTAs to treat their members. Do you have a document or reference stating so?

  3. Do you know if ChampVA is included with this change? I’m wondering if they follow Tricare rules or their own. ChampVa has also never covered treatment from an assistant.

    1. ChampVA and TRICARE are not the same so the rule applies only to TRICARE. Do you have something in writing from ChampVA stating they do not cover services provided by a PTA or OTA.