TRICARE Physical Therapy: Coverage, Referrals, & Costs

## Quick answer TRICARE covers physical therapy (PT) when it is medically necessary to improve function, relieve pain, or prevent disability following an illness or injury. While most beneficiaries can see an in-network physical therapist without a referral under Select plans, Prime members generally require a referral from their Primary Care Manager (PCM) to avoid higher point-of-service costs.

*Note: TRICARE.com is an independent reference site and is not affiliated with the Department of Defense. For official policy, visit TRICARE.mil.*

Details

### Referral and Authorization Requirements Requirements for physical therapy depend entirely on your specific plan and your beneficiary status:

* **Active Duty Service Members (ADSMs):** You **always** need a referral and prior authorization from your PCM for physical therapy, whether on-base or at a civilian provider. * **TRICARE Prime (Non-ADSM):** You typically need a referral from your PCM. If you see a physical therapist without a referral, you will be charged under the "Point-of-Service" option, which carries a much higher deductible and 50% cost-shares. * **TRICARE Select:** You do not need a referral for PT, but the provider must be TRICARE-authorized. Using a network provider will result in lower out-of-pocket costs.

### What is Covered? TRICARE covers PT to treat specific medical conditions, such as: * Post-surgical rehabilitation (e.g., knee or hip replacements). * Recovery from acute injuries (e.g., sprains, fractures). * Treatment for chronic conditions that impact mobility or daily function. * Therapeutic exercises, whirlpool, ultrasound, and manual therapy.

### What is NOT Covered? TRICARE will not pay for PT that is considered maintenance, palliative, or for general fitness. Specific exclusions include: * Diathermy, ultrasound, and heat treatments for sensory paralysis. * Manual traction (when not part of a larger treatment plan). * Services billed as "educational" or "vocational" in nature. * General exercise programs to improve lifestyle rather than treat a specific injury.

### 2026 Costs and Copays Costs depend on your "Group" status (Group A joined before 2018; Group B joined after) and your specific plan.

* **TRICARE Prime:** $0 copay for active duty family members (ADFMs) at network providers. Retirees pay a small per-visit copay (typically around $25–$35 for 2026, though specific amounts vary by sub-plan). * **TRICARE Select:** * **Group A ADFMs:** ~$25–$35 per visit after meeting the deductible. * **Group A Retirees:** ~$45–$55 per visit. * **TRICARE For Life:** TRICARE typically acts as the secondary payer to Medicare. If Medicare covers the PT, TRICARE usually covers the remaining out-of-pocket costs.

### Regional Management * **East Region:** Managed by Humana Military. * **West Region:** Managed by TriWest Healthcare Alliance (as of early 2025). Providers must submit claims to the respective regional contractor.

## Who this affects * **Active Duty Service Members:** Highest level of oversight; requires 100% authorization. * **Active Duty Family Members:** Impacted by Prime vs. Select choice regarding referrals. * **Retirees and their Families:** Subject to copays and potential cost-shares. * **National Guard/Reserve:** Includes those on TRICARE Reserve Select (TRS). * **TRICARE For Life (TFL) Beneficiaries:** Coverage is coordinated with Medicare.

## Sources 1. TRICARE.mil Physical Therapy Benefit: https://tricare.mil/CoveredServices/IsItCovered/PhysicalTherapy 2. Humana Military (East Region): https://www.humanamilitary.com/ 3. TriWest Healthcare Alliance (West Region): https://www.triwest.com/ 4. TRICARE.mil Copays and Cost-Shares: https://tricare.mil/costs