How does TRICARE cover physical therapy?
Quick Answer
TRICARE covers physical therapy with authorization for medically necessary rehabilitation. Prime members need a referral; Select members can self-refer to network providers.
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Key Takeaways
- PT is covered when medically necessary
- Prime needs referral, Select does not
- Extended care needs authorization
- Network providers cost less
Detailed Answer
Physical therapy is covered for rehabilitation and recovery from injuries or conditions.
Coverage Details
- Outpatient physical therapy covered
- Inpatient PT during hospital stays
- Occupational therapy also covered
- Speech therapy included
Authorization Requirements
- Initial evaluation often covered without prior auth
- Extended treatment needs authorization
- Provider requests additional visits
- Medical necessity must be demonstrated
TRICARE Prime
- Referral from PCM required
- Network PT providers
- Copays apply
- Authorization for extended care
TRICARE Select
- No referral needed
- Can use any authorized provider
- Network saves money
- Cost shares apply
Number of Visits
- No specific visit limit
- Based on medical necessity
- Authorization for extensions
- Regular progress reviews
Related TRICARE Terms
Related Questions
What services does TRICARE cover?
TRICARE covers preventive care, doctor visits, hospitalization, surgery, mental health, maternity, prescriptions, and more with some requiring authorization.
What services require prior authorization?
Prior authorization is needed for many inpatient stays, some surgeries, specialty services, DME, and certain high-cost procedures regardless of plan.
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
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