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Tricare and Therapist Assistants

In light of the final ruling on the National Defense Authorization Act FY 2018 (NDAA), we have some exciting changes coming! As of April 16, 2020, licensed or certified physical therapist assistants (PTAs) and occupational therapist assistants (OTAs) are officially considered authorized Tricare providers. Additionally, Tricare has aligned with Medicare’s policies for the reimbursement and supervision of therapist assistants. You’re probably wondering what this means for your practice, so here are the frequently asked questions in regards to Tricare. 

Does Tricare cover services performed by a therapist assistant?

Tricare pays for the healthcare services of authorized providers under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). Physical therapists and occupational therapists can cost-share in Tricare fees when services are prescribed by a physician, PA, or certified nurse practitioner. As long as PTAs and OTAs satisfy the educational and state licensure requirements under Medicare, PTAs and OTAs are qualified as a covered service.

Will Tricare reimburse services performed by a therapist assistant?

Medicare reimbursement requirements will be adopted and Medicare’s pay differential will be applied. This requires the application of the CO or CQ modifier and reimbursement at 85% for therapy services in 2022. OTA and PTA services cannot be reimbursed for evaluation and re-evaluation services. These services are to be billed under the licensed therapist’s NPI and must be furnished under the supervision of the Tricare-authorized registered physical therapist.

Are there PTAs and OTAs supervision requirements?

The supervising physical therapist and occupational therapist must be a Tricare authorized provider, which will require the PT and OT to be credentialed with Tricare to bill for the assistant’s services. Supervision requirements will conform with Medicare requirements; however, if state or local supervision requirements are stricter, those will apply. 

In private practices, the assistant must work under direct supervision. When the assistant is providing the services in private practice, a licensed therapist must be in the office suite and immediately able to furnish assistance and direction to the assistant.

In all other practice settings, the assistant must work under general supervision. When the assistant is providing the services, a licensed therapist is not required to be present.

Tricare Alert on Patient Appointments

When scheduling an appointment for a patient with Tricare, the following alert may appear.

You can remove this alert from your Tricare payers by following these steps.

  1. From the Insurance manager, select Display Insurance.
  2. Edit the Tricare payer.
  3. Remove the Appointments alert.
  4. Click Edit Insurance to save.
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