UPDATE: TRICARE policy does not allow for therapy to be paid when it is provided by a physical therapist assistant (PTA) regardless of setting.
As a result of a previous post many providers called their TRICARE regions to find out that the provider manual for those regions did not specifically mention exclusions related to therapy provided by physical therapists assistants (PTAs). Another provider contacted me to indicate that she uses the underlying federal regulations as a guideline, even through the prohibition against PTAs is not in her region’s manual.
TRICARE and Private Practice PTA – Policy in the Code of Federal Regulations
To clarify, the exclusion of PTAs as providers is applicable to all settings. Therapy providers utilizing PTAs (under appropriate supervision) in hospitals and other institutional providers such as Rehab Agencies and CORFs are subject to the PTA exclusion.
Do you provide services under TRICARE (a Federal health care program)? Do you use physical therapist assistants? Do you have a facility policy in your outpatient therapy setting for therapy services provided to TRICARE enrollees? Have staff been trained on this policy?