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Low Back Pain Physical Therapy Demonstration

Tuesday, December 29, 2020

Effective Jan. 1, 2021, the Defense Health Agency (DHA) has authorized a new pilot titled, "Low Back Pain Physical Therapy Demonstration." This demonstration will waive cost-sharing for up to three physical therapy (PT) visits for patients with low back pain (LBP) and is limited to beneficiaries in 10 states, including the following states in the West region: Arizona, California and Colorado. The purpose of this demonstration is to evaluate whether waiving the cost sharing responsibility increases beneficiary participation in PT; decreases low-value care; and/or decreases the overall cost of care for treating patients with LBP.

Summary of Requirements

  • This demonstration applies to new PT episodes of care only. TRICARE patients who were receiving PT services before Jan. 1, 2021, may not receive waived cost-shares for services received after the start of the demonstration. 
  • A TRICARE-authorized provider must refer beneficiaries to treatment.
  • A network provider must provide the PT services. (Exception: TRICARE For Life beneficiaries may receive PT services from a non-network TRICARE-authorized provider.)
  • There is no time limit between the onset of symptoms and receiving PT services under this demonstration.
  • Visits for acute, subacute or chronic LBP may be eligible for this benefit.
  • After the third, cost-share waived PT session, beneficiaries will be responsible for standard cost-shares for future sessions.

Eligibility

  • This demonstration is limited to beneficiaries who reside in and receive care in the following states: Arizona, California, Colorado, Florida, Georgia, Kentucky, North Carolina, Ohio, Tennessee, and Virginia.
  • TRICARE Prime, TRICARE Select, TRICARE For Life (TFL), TRICARE Ready Reserve (TRR), TRICARE Reserve Select (TRS), and TRICARE Young Adult (TYA) beneficiaries residing and receiving care in the above named states are eligible to participate.

To learn more about TRICARE’s physical therapy benefit, visit the Physical Therapy section of Benefits A–Z.