Tricare Prime Physical Therapy Copay

Tricare Prime Physical Therapy Copay
Tricare Select Physical Therapy
Tricare Prime Retiree Physical Therapy Copay

Coronavirus (COVID-19) Update:

Testing copayment waiver: Retroactive to March 18, 2020, TRICARE will waive copayments/cost-shares for medically necessary COVID-19 diagnostic and antibody testing and related services, and office visits, urgent care or emergency room visits during which tests are ordered or administered. COVID-19 diagnostic and antibody tests must meet Families First Coronavirus Response Act (FFCRA) criteria in order to be eligible for the cost-share and copayment waivers.
Telemedicine copayment waiver: TRICARE is waiving copayments and cost-shares for covered audio-only or audio/video telemedicine rendered by network providers on or after May 12, 2020. This waiver applies to covered in-network telehealth services, not just services related to COVID-19. Beneficiaries who seek telehealth from non-network providers are liable for their regular copayment or cost-share. TRICARE Prime beneficiaries who seek care from specialists without an approved referral when required are subject to Point of Service fees.

Providers are expected to refund cost-sharing amounts to beneficiaries as appropriate.

TRICARE Prime Remote (TPR) An assigned civilian PCM works with Humana Military to issue a referral or authorization for all services they are unable to perform. Urgent care does not require a referral if you see a TRICARE-authorized provider (network or non-network). Emergency care through an ER for a true emergency does not require a referral. Update your TRICARE eligibility status. To update eligibility status for a family member, contact the Defense Enrollment Eligibility Reporting System (DEERS) at (800) 538-9552 and verify what documentation is required for the change. It is the responsibility of the TRICARE beneficiary, parent or legal representative to report a change in status. Physical therapy to treat a physical or occupational deficiency due to a cognitive or developmental disorder for beneficiaries age three to 21 requires a physician letter of attestation whenever there is evidence presented to TRICARE that there is an individualized education program in place for special education services. Physical therapy helps you gain greater self-sufficiency, mobility, and productivity through exercises and other modalities intended to improve muscle strength, joint motion, coordination, and endurance. TRICARE doesn't cover the physical therapy services below. This list isn't all inclusive.

Note: Visit our Copayment and Cost-Share Information page to view 2020 costs.

TRICARE Select, TRICARE Young Adult Select, TRICARE Reserve Select, and TRICARE Retired Reserve annual deductibles apply.
TRICARE Young Adult costs are based on the sponsor's status.
TRICARE Prime and TRICARE Young Adult Prime retirees have a separate copayment for allergy shots performed on a different day than the office visit, or performed by a different provider, such as an independent laboratory or radiology facility (even if performed on the same day as the related office visit).
Transitional Assistance Management Program (TAMP) beneficiaries (service members and their family members) follow the active duty family member copayment/cost-share information, based on the TRICARE plan type.

A beneficiary's cost is determined by the sponsor's initial enlistment or appointment date:

Group A: Sponsor's enlistment or appointment date occurred prior to Jan. 1, 2018.
Group B: Sponsor's enlistment or appointment date occurred on or after Jan. 1, 2018.

TRICARE Prime and TRICARE Prime Remote (not including TRICARE Young Adult)

Service	Active Duty Family Members	Retirees and Their Family Members
Primary Care Outpatient Office Visits	Group A: $0 Group B: $0	Group A: $21 Group B: $21
Specialty Care Outpatient Office Visits (this includes physical, occupational and speech therapy, and provisional coverage benefits)	Group A: $0 Group B: $0	Group A: $31 Group B: $31

Service

Active Duty Family Members

Retirees and Their Family Members

Primary Care Outpatient
Office Visits

Group A: $0

Group B: $0

Group A: $21

Group B: $21

Specialty Care Outpatient
Office Visits

(this includes physical, occupational
and speech therapy, and provisional coverage benefits)

Group A: $0

Group B: $0

Group A: $31

Group B: $31

TRICARE Select (not including TRICARE Young Adult)

Service	Active Duty Family Members	Retirees and Their Family Members
Primary Care Outpatient Office Visits	Group A: Network Provider: $22 Non-Network Provider: 20% Group B: Network Provider: $15 Non-Network Provider: 20%	Group A: Network Provider: $30 Non-Network Provider: 25% Group B: Network Provider: $26 Non-Network Provider: 25%
Specialty Care Outpatient Office Visits (this includes physical, occupational and speech therapy, and provisional coverage benefits)	Group A: Network Provider: $34 Non-Network Provider: 20% Group B: Network Provider: $26 Non-Network Provider: 20%	Group A: Network Provider: $46 Non-Network Provider: 25% Group B: Network Provider: $42 Non-Network Provider: 25%

Service

Active Duty Family Members

Retirees and Their Family Members

Primary Care Outpatient
Office Visits

Group A:

Network Provider: $22
Non-Network Provider: 20%

Group B:

Network Provider: $15
Non-Network Provider: 20%

Group A:

Network Provider: $30
Non-Network Provider: 25%

Group B:

Network Provider: $26
Non-Network Provider: 25%

Specialty Care Outpatient
Office Visits

(this includes physical, occupational
and speech therapy, and provisional coverage benefits)

Group A:

Network Provider: $34
Non-Network Provider: 20%

Group B:

Network Provider: $26
Non-Network Provider: 20%

Group A:

Network Provider: $46
Non-Network Provider: 25%

Group B:

Network Provider: $42
Non-Network Provider: 25%

TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR)