Covered Services

Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services. Beneficiaries have an out-of-pocket maximum for covered medical expenses; this is known as the catastrophic cap. Physical therapy to treat a physical or occupational deficiency due to a cognitive or developmental disorder for beneficiaries age three to 21 requires a physician letter of attestation whenever there is evidence presented to TRICARE that there is an individualized education program in place for special education services.

TRICARE covers physical therapy when:

• Provided by:
  • A Licensed Physical Therapist (PT), or Physical Therapist Assistant (PTA) performing under the supervision of a TRICARE-authorized PT
  • An Occupational Therapist (OT), or Occupational Therapist Assistant (OTA) performing under the supervision of a TRICARE-authorized OT
• Professionally administered to aid in the recovery from disease or injury

Physical therapy helps you gain greater self-sufficiency, mobility, and productivity through exercises and other modalities intended to improve muscle strength, joint motion, coordination, and endurance.

TRICARE doesn't cover the physical therapy services below. This list isn't all inclusive.

• Diathermy, ultrasound and heat treatments for pulmonary conditions
• General exercise programs
• Electrical nerve stimulation to treat upper motor neuron disorders, such as multiple sclerosis
• Separate charges for instruction of the patient and family in therapy procedures
• Repetitive exercise to improve gait, maintain strength and endurance, and assistive walking
• Range of motion and passive exercises not related to restoring a specific loss of function
• Maintenance therapy
• Services provided by a chiropractor or naturopath
• Acupuncture
• Athletic training evaluation
• Non-surgical spinal decompression therapy
• Use of powered traction devices

Contact your regional contractor for specific limitations to the physical therapy benefit.

If you've been diagnosed with low back pain after Jan. 1, 2021, you may be eligible for the Lower Back Pain and Physical Therapy Demonstration.

This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.

Tricare Select Physical Therapy Copay Benefits

Last Updated 1/8/2021

Tricare West Physical Therapy Providers

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Costs

Tricare Select Physical Therapy Copay Plan

• Most costs are for calendar year 2021 unless noted separately.
• For US Family Health Plan and TRICARE Prime Remote costs, choose 'TRICARE Prime' from the pull-down menu
• Visit the Cost Terms page for definitions to help you better understand TRICARE costs.
• If you're an unremarried former spouse, for the Continued Health Care Benefit Program (CHCBP), chose 'Retired' regardless of your sponsor's status
• Looking for dental costs? Visit the TRICARE Dental Costs section.

Tricare And Physical Therapy

Tricare Select Physical Therapy Copay

Tricare Select Physical Therapy Benefits

Copayments will be waived retroactively to March 18 for certain testing and office visits related to the testing. The test must be one approved, cleared, or authorized by the Food and Drug Administration to detect SARS-CoV-2 or diagnose COVID-19. If you paid any copayments for testing related to COVID-19 and the resulting office visits with a network or non- network provider, you may file a claim for reimbursement. For more information related to the coronavirus, visit the FAQ page.