The Director, Defense Health Agency (DHA), has approved the creation of a demonstration to waive cost-sharing for up to three physical therapy (PT) visits for TRICARE beneficiaries with low back pain (LBP).
Dates of the Demonstration
This demonstration project will be effective
The following states were selected as demonstration states:
Description of the Demonstration
Provider Requirements under the Demonstration
Purpose of the Demonstration
Other Relevant Details
To read all about the demonstration project, click
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For tricare you only mention PTS
What about OTs hand therapist
How does that work
Currently we are out of network but get auths for those patients
Is the in network payment different from out of network
Please advice the benefits of being in network
This article discusses LBP Demonstration project. OTs do not treat the low back.
Question on 3D printed splints
We at OT/CHT provide custom orthosis that is paid by Medicare though more and more insurance companies are giving us trouble with reimbursements despite the obvious benefits patients have
Now with the advent of 3D splints (Medicare is refusing to pay for the same splint in less than 5 years even though the material property doesn’t last) and these patients benefit from the splints to prevent further surgeries if we provide 3D splints are they reimbursed and at what rate since they can last 5 years (hopefully)
Do you know and can advice on it
This would fall under my consulting services if you are interested.
Good to Know does the referral have to come from an MD at a VA facility as most of ours do or if the patient has a PCP or Ortho MD outside VA clinic can a referral come form them also?
This is the language from the ruling: To comply with existing statutory and regulatory requirements for TRICARE, physical therapy must be prescribed by a provider listed at title 32, Code of Federal Regulations, §199.6(c)(3)(iii)(K)(2)