TRICARE covers physical therapy from a licensed physical therapist when it is professionally administered to help you recover from a disease or injury; it excludes general exercise programs and maintenance therapy. TRICARE Prime members get referrals through their primary care manager and regional contractor, TRICARE Select members do not need referrals for most care but may need pre-authorization, and TRICARE For Life pays after Medicare. The matching team asks about your TRICARE plan and tells you honestly whether a therapist in the network can see you under it.
Last reviewed By the Monon Therapy Collective editorial team
- Covered
- Therapy to aid recovery from disease or injury
- Not covered
- General exercise programs and maintenance therapy
- Prime
- Primary care manager refers; contractor authorizes
- Select
- Most care without referral; some pre-authorization
What physical therapy does TRICARE cover and exclude?
TRICARE covers physical therapy when a licensed physical therapist, or a physical therapist assistant working under the supervision of a TRICARE-authorized therapist, provides it and it is professionally administered to aid recovery from a disease or injury. That is the language on TRICARE’s own coverage page, and it describes the rehab most people need after a sprain, a strained back or surgery.
The same page lists what is not covered. TRICARE says to contact your regional contractor for specific limits on the physical therapy benefit.
- General exercise programs
- Maintenance therapy
- Services by a chiropractor or naturopath
- Acupuncture
- Non-surgical spinal decompression therapy
- Diathermy, ultrasound and heat treatments for pulmonary conditions
How do referrals for physical therapy work on TRICARE Prime?
On Prime, your primary care manager (PCM) is the gateway. TRICARE describes the PCM as the provider who refers you to specialists for care they cannot provide and who works with the regional contractor for referrals and authorization, so ask your PCM for a physical therapy referral before you book outside a military clinic.
Active duty service members pay nothing out of pocket on Prime, and their family members pay nothing except when they use the point-of-service option, so ask your PCM or regional contractor how that option applies before booking therapy without a referral. Active duty members often have extra rules set by their command and military clinic, so check with your PCM first.
Does TRICARE Select need a referral for physical therapy?
Usually not. TRICARE says referrals are not required for most primary and specialty appointments on Select, and you can book with any TRICARE-authorized provider, though some services need pre-authorization.
You pay an annual outpatient deductible and copayments or cost-shares, and some beneficiaries pay enrollment fees. The amounts depend on your beneficiary category and whether the provider is in the TRICARE network, so check the current costs table on tricare.mil or call your regional contractor. Humana Military is the TRICARE East Region contractor, and TRICARE notes that some Indiana ZIP codes fall in the West Region instead, so enter your ZIP code on tricare.mil to confirm which contractor handles your care.
How does TRICARE For Life pay for therapy alongside Medicare?
Medicare pays first and TRICARE For Life pays second. TRICARE For Life is wraparound coverage for TRICARE-eligible people who have Medicare Part A and Part B, and you must keep paying Part B premiums. After Medicare pays its share, the claim crosses to the TRICARE For Life processor, which pays the provider directly for TRICARE-covered services.
That means Medicare’s therapy rules apply first, including the physician-certified plan of care described on the page about Medicare and physical therapy. Look for a provider who works with Medicare.
How can a military family near Carmel get started?
Start with your plan type, then the referral, then the provider. Prime members call their PCM; Select members check whether pre-authorization applies; TRICARE For Life members confirm the provider works with Medicare. The same questions about visit limits and authorization apply as on the page about how many visits insurance covers.
Veterans who use VA health care rather than TRICARE follow a different route through VA Community Care. Either way, the two-minute questionnaire tells the matching team your plan and the problem, so it can say honestly whether a therapist in the network fits.
