Note: This post was last updated April 23, 2020.
Okay, everyone, are you ready for some good news? I know I am. After much delay, physical therapist assistants and occupational therapy assistants may begin treating Tricare patients starting April 16, 2020. Rejoice!
As we initially reported here, on December 12, 2017, President Trump signed the National Defense Authorization Act, opening the door for PTAs and OTAs to join the Tricare payment program and establishing supervision requirements for therapist assistants treating Tricare patients. However, there was still a lot of confusion—especially with regard to when, exactly, this change would actually take effect.
Finally, we have answers.
Thanks to a long-awaited final rule passed down from the Department of Defense (DoD), starting April 16, 2020, all eligible PTAs and OTAs may begin treating Tricare patients and receiving reimbursement under the Tricare program. The final rule also includes other related specifications. Some key takeaways—as adapted from this APTA resource—are:
- Tricare’s qualification and supervision requirements will be similar to Medicare’s. A licensed physical therapist (PT) or occupational therapist (OT) must provide direct supervision of the PTA or OTA, respectively, in private practice settings.
- Outside of private practice, the assistant must be under general supervision.
- When federal law conflicts with state or local supervision laws, the therapist and assistant must follow whichever law is more stringent. If, for example, the federal law requires general supervision but the state requires the supervising therapist to be in the same room with the assistant while he or she renders services, the therapist and assistant must follow the state law.
- Like other payers, Tricare will not pay for any service—skilled or otherwise—rendered by a physical therapy aide or physical therapy tech.
- Per the APTA’s recommendation, the DoD has shifted its terminology and now refers to PTAs as “physical therapist assistants” as opposed to “physical therapy assistants.”
Additionally, as of April 22, Tricare has revised its policy manual to account for this change. Per that revision, Tricare—like Medicare—requires the use of the CQ modifier when more than 10% of a service is provided by an assistant. While the APTA reports that this modifier should not affect claims processing, in the event of a denial, the association says claims may need to be resubmitted.
If any new Tricare information comes down the pike, we’ll be sure to keep you updated. But for now, we hope this bit of positive news brings a smile to your face. Have Tricare questions? Let us know in the comment section below!