On December 12, 2017, President Trump signed the National Defense Authorization Act (NDAA) into law. One important piece of legislation included in the NDAA directs the Department of Defense (DOD) to add physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) to the TRICARE program as an eligible provider of therapy services.
Even though the NDAA is now law, the DOD must now make the change to add PTAs and OTAs as eligible providers of therapy services. The DOD must also establish, in regulations, requirements for the supervision of PTAs and OTAs. Until this is completed, PTAs and OTAs are still unable to treat TRICARE beneficiaries and bill for those services.
So, when do we expect this change to occur and finally allow PTAs and OTAs to treat TRICARE beneficiaries? Before PTAs and OTAs can treat TRICARE patients, the DOD will have to publish
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.
We currently use PTAs and OTAs to treat Tricare patients in our acute care hospital, swing bed facility, and in our outpatient clinic. We bill under the hospital’s NPI, not separate therapist identifiers, and have not had a denial to date that I’m aware of. Are we at risk for nonpayment of Tricare/Medicare claims with this practice?
PTAs and OTAs can’t treat TRICARE patients. You are in violation of the TRICARE rules and regulations.
Can a PTA treat a patient where Tricare is a secondary insurance?
If billing TRICARE at all, the services can’t be provided by a PTA or an OTA.
Does this pertain to PTA’s and Veteran’s Affairs patients too?
The article only addresses TRICARE.
Any further updates on this matter at this time?
No! Please read near the bottom of the article of when we expect changes to occur.
I have read the Tricare manual in regards to “authorized providers” and I am still are not quite sure:
Are services provided by a student billable if those services are provided under direct supervision by an authorized provider?
Tricare pays for the services when they are provided by a physical therapist, occupational therapist, and speech language pathologists. If you stil have questions, I would recommend you contact your professional association.
Does this include ChampVA?
The article I wrote applies only to TriCare