VA Community Care lets an enrolled veteran get physical therapy from a provider outside the VA, paid by the VA, but only with approval from your VA health care team before the first visit and only from a provider in the VA’s community care network. Eligibility rests on criteria such as the VA not offering the service nearby or the VA’s drive-time and wait-time standards; for specialty care those are a 60-minute average drive or a 28-day wait. The matching team tells you honestly whether a therapist in the network is a community care provider before anything is booked.
Last reviewed By the Monon Therapy Collective editorial team
- Before care
- Approval from your VA health care team
- Specialty standard
- 60-minute average drive or 28-day wait
- Referral review
- Can take up to 14 days
- Provider
- Must be in the VA’s community care network
Who qualifies for physical therapy through VA Community Care?
You must be enrolled in or eligible for VA health care, and your VA health care team must approve community care before you go. On top of that, you need to meet at least one of the VA’s eligibility criteria, such as the VA not offering the service you need, living where the VA cannot meet its access standards, or you and your VA provider agreeing that community care makes medical sense for you.
The access standards are concrete. For primary care, mental health and extended outpatient care they are a 30-minute average drive or a 20-day wait; for specialty care they are a 60-minute average drive or a 28-day wait. Ask your VA team which standard applies to physical therapy for you.
What does the VA authorization letter control?
Everything about what the VA will pay. After the appointment is scheduled, the VA sends an authorization letter with an authorization number, the community provider’s details, a description of the approved care and how long the approval lasts.
The VA says it will not cover services the letter does not include. If your therapist recommends more visits than were approved, or a new problem appears, a new referral is needed. Keep the letter handy and track how many visits you have used against the approved number.
Do veterans pay anything for community care physical therapy?
Possibly a VA copay. The VA states that, as with care provided directly by the VA, veterans are charged a copayment for nonservice-connected care in the community; care for a service-connected condition is treated differently.
Whether you owe a copay, and how much, depends on factors the VA lists such as your priority group, any service-connected disability rating and your income, and the VA bills it rather than the therapist, so ask your VA team before you start. The cost and insurance page explains how other kinds of coverage are checked.
What if I disagree with a community care decision?
You can use the VA’s clinical appeals process. The VA says your facility’s chief medical officer, or someone they designate, reviews the appeal and any relevant medical records.
Before appealing, ask your VA team exactly which criterion was not met; sometimes the answer is a scheduling problem that a different provider or date solves. Veterans with TRICARE as well should read about TRICARE and physical therapy, which follows separate rules.
What does rehab look like for veterans in Carmel?
The same as for anyone, built around your goals. Common reasons veterans seek therapy include chronic low back pain, knee and shoulder problems from years of loaded marches and lifting, and recovery after surgery. Sessions in the private suites at Carmel City Center are one-on-one in a closed room.
How do I get a VA Community Care referral for physical therapy?
These are the steps the VA describes for community care referrals and appointments.
Find a provider
Search for an in-network community provider yourself, or ask your VA health care team to find one for you.
Ask for a referral
Ask your VA health care team for a referral to the community provider. The VA reviews your eligibility and contacts you to confirm your care needs; this can take up to 14 days.
Schedule the appointment
Schedule it yourself or ask your VA team to schedule for you. If you schedule it yourself, tell your VA team within 14 days.
Receive your authorization letter
The VA sends a letter with your authorization number, the provider, the approved care and how long the approval lasts.
Attend the appointment
The VA shares your records with the provider. Bring copies of any imaging, such as MRI or CT scans, the provider asks for.
Track ongoing care
Keep count of approved visits and the approval period, and ask for a new referral if you need more care.
