TRICARE Questions and Answers
I receive many questions about the TRICARE program and thought I would take the time to write an article and provide answers to the questions I receive. If you have additional questions about TRICARE and outpatient therapy, please post them below in the comment box and if appropriate, I’ll add the question and answer to this article.
Question
How many regions are there in the United States that manage the TRICARE program?
Answer
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Question
Who is the regional contractor for the West Region?
Answer
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Question
What states are located in the West Region?
Answer
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Question
Who is the regional contractor for the East Region?
Answer
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Question
What states are located in the East Region?
Answer
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Question
Does TRICARE follow Medicare’s “8-minute rule” when providers are billing for outpatient therapy services?
Answer
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Question
Does TRICARE pay for services provided by a physical therapist assistant or occupational therapy assistant under the appropriate supervision of a physical therapist or occupational therapist respectively?
Answer
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Question
Has TRICARE implemented the CQ and CO modifiers if services are provided in part or in whole by a physical therapist assistant or occupational therapy assistant?
Answer
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Question
Will TRICARE reduce the amount of reimbursement when services are provided “in whole” or “in part” by a physical therapist assistant or occupational therapy assistant?
Answer
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Question
Does TRICARE cover Transcutaneous Electrical Nerve Stimulation?
Answer
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Question
Does TRICARE pay for the dry needling CPT codes 20560 and 20561 if performed under a physical therapy plan of care?
Answer
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Question
Is TRICARE and CHAMPUS the same?
Answer
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Question
Is TRICARE and ChampVA the same?
Answer
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Question
How can I access the TRICARE manual?
Answer
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I hope you found the above questions and answers helpful. If you have additional questions, please leave them in the comment box. Thank you for being a Gold Member!
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Has Tricare already implemented the cut for PTA’s performing services over 10%?
No
Thank you for this information. It was very helpful.
Can you please clarify the statement about TENS not being covered? Does this mean CPT code 97014 when other electrical stimulation is utilized in clinic such as Interferential or pre-mod? Does it mean that it will cover CPT code 97014 for other body parts such as shoulder pain. The manual specifically only mentions Low Back Pain as the diagnosis it will not cover.
You can’t provide TENS to a TRICARE patient and bill for it under 97014 or any other CPT code.
Does Tricare limit the number of units per day like BCBS does?
You would want to look at your contract to see if there are any limitations.
Will Tricare pay for services peformed by a PT student or PTA student?
TRICARE pays for therapy services when provided by a PT, PTA, OT, OTA or SLP.