How many physical therapy visits does TRICARE allow?
Quick Answer
TRICARE has no strict visit limit for physical therapy. Coverage is based on medical necessity. Extended treatment may require prior authorization. Prime needs a PCM referral, while Select allows direct access to network physical therapists.
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Key Takeaways
- No strict visit limit for physical therapy under TRICARE
- Coverage depends on documented medical necessity and progress
- Prime requires a PCM referral; Select allows direct access
- Extended treatment may require prior authorization
Detailed Answer
TRICARE covers physical therapy without a fixed visit limit, but continued treatment must be medically necessary and demonstrate progress toward treatment goals.
Coverage Basics
- No specific annual visit cap for physical therapy
- Coverage is based on medical necessity
- Treatment must be prescribed by a physician or authorized provider
- Outpatient and inpatient PT are both covered
- Occupational therapy and speech therapy follow similar rules
TRICARE Prime
- Referral from your PCM is required
- Your PCM refers you to a network physical therapist
- Initial referral typically covers a set number of visits
- Additional visits require a new referral or extension
- MTF physical therapy is available at no cost
TRICARE Select
- No referral needed for physical therapy
- Can go directly to any TRICARE-authorized physical therapist
- Network providers have lower cost-shares
- Non-network providers accepted but at higher cost
- No pre-authorization needed for initial evaluation
Authorization for Extended Treatment
- If treatment extends beyond what is typically expected, authorization may be required
- Your physical therapist documents progress and medical necessity
- Regional contractor reviews authorization requests
- Continued coverage depends on documented improvement
- Authorization denials can be appealed
What Is Covered
- Initial evaluation and treatment planning
- Therapeutic exercises and stretching
- Manual therapy and joint mobilization
- Modalities (ultrasound, electrical stimulation, heat/ice)
- Balance and gait training
- Post-surgical rehabilitation
- Sports injury rehabilitation
- Chronic pain management
Costs
- Active duty: No cost at MTF or with referral
- Active duty families (Prime): Low copay per visit
- Retirees (Prime): Standard outpatient copay
- Retirees (Select): 20-25% cost-share for network providers
- Higher costs for non-network providers under Select
Tips for Getting the Most from PT
- Follow your home exercise program consistently
- Communicate progress and setbacks to your therapist
- Keep all follow-up appointments
- Discuss treatment goals and expected timeline with your provider
Helpful Tips
- Follow your home exercise program to maximize progress and avoid extended treatment
- Ask your therapist to document progress clearly to support continued authorization
- Use MTF physical therapy services when available for no-cost treatment
Related TRICARE Terms
Related Questions
What's the difference between a referral and prior authorization?
Referrals allow you to see specialists (Prime requirement). Prior authorization is approval needed before certain services regardless of plan.
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.
How does TRICARE cover physical therapy?
TRICARE covers physical therapy when medically necessary. Outpatient PT may have visit limits, and authorization requirements vary by 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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