PTA and OTA Participation in TRICARE: The Process is Underway

Military healthcare program expanding coverage following extensive lobbying campaign.

The U.S Department of Defense has signaled the start of the process to authorize physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) as TRICARE providers. This mandate was specified under Section 721 of the 2018 National Defense Authorization Act (NDAA).

Physical therapists (PTs) and occupational therapists (OTs) are currently authorized providers under TRICARE. The therapy industry was largely aware of the TRICARE regulations on the prohibition of cost sharing in private practice settings. Nearly two years ago, however, TRICARE signaled to the therapy community that the prohibition on the use of PTAs and OTAs extended to all settings, including hospitals, Skilled Nursing Facilities (SNFs), rehab agencies, and Comprehensive Outpatient Rehabilitation Facilities (CORFs). 

Lobbying by the therapy community and national therapy organizations to members of Congress throughout 2017 was successful in obtaining language in the 2018 NDAA to direct TRICARE to add PTAs and OTAs as authorized providers. And so, the journey took a first tiny step, with words of caution that the process might take as long as two years.   

It has been a year now, and we are on the way, with the Notice of Proposed Rule Making (NPRM) being issued. What is the expected timeline? Comments on the Proposed Rule are due Feb. 19, 2019. There is optimism that the process may be completed sometime this year – so the two-year estimate may be accurate.

Comments can be submitted via mail (see address in the Proposed Rule) or via the Federal Rulemaking Portal. At first glance, there are a few items in the rule requiring correction and clarification. These include the following:

  1. There is an incorrect reference to PTAs as “physical therapy assistants” rather than “physical therapist assistants.”
  2. There is reference to Medicare supervision requirements that describe “direct” supervision as “in the room,” rather than “in the office suite,” as defined in the Medicare Benefits Policy Manual, Sections 220-230 of Chapter 15, for therapy services.
  3. There are statements regarding billing for PTA and OTA services under the TRICARE- authorized supervising physical or occupational therapist’s provider identification (ID). Therapists working in facility settings are not individually enrolled in TRICARE, and the claims are submitted by the facility (e.g., hospital).

Access the Proposed Rule – Contact the American Physical Therapy Association (APTA), American Occupational Therapy Association (AOTA), the National Association or Rehabilitation (NARA), or other therapy advocacy groups for guidance on comments. If your practice or facility services the TRICARE community and you have been challenged by the inability to use qualified PTAs and OTAs to meet patient needs and scheduling in the past, this is a great opportunity to be heard.   

Program Note:
Listen to Nancy Beckley on Monitor Monday every Monday, 10-10:30 a.m. Eastern.

 

Comment on this article

Facebook
Twitter
LinkedIn

Nancy J. Beckley, MB, MBA, CHC

Nancy Beckley is founder and president of Nancy Beckley & Associates LLC, providing compliance planning and outsourced compliance services to rehab providers in hospitals, rehab agencies, and private practices. Nancy is certified in healthcare compliance by the Healthcare Compliance Certification Board. She is on the board of the National Association of Rehabilitation Providers and Agencies. She previously served on the CMS Professional Expert Technical Panel for Comprehensive Outpatient Rehabilitation Facilities. Nancy is a familiar voice on Monitor Mondays, where she serves as a senior national correspondent.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2026 IPPS Masterclass 3: Master MS-DRG Shifts and NTAPs

2026 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 14, 2025
2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 13, 2025
2026 IPPS Masterclass 1: Master ICD-10-CM Changes

2026 IPPS Masterclass Day 1: Master ICD-10-CM Changes

This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 12, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24