The following resources provide payment information related to payment under the Department of Veterans Affairs (VA) and payment under TRICARE.
For additional assistance with payment and reimbursement issues, contact APTA's Payment Policy & Advocacy department at 800/999-2782, ext 8511 or firstname.lastname@example.org.
The Department of Veterans Affairs (VA) oversees the Veterans Health Administration (VHA), which covers only veterans—those who once served in the military and no longer are in active duty or who are retired veterans who also meet certain eligibility and health criteria.
VA News & Updates
TRICARE is a civilian network administered by the US Department of Defense that provides health care benefits to active-duty service members, National Guard/reserve members, and their families when services cannot be provided at a military treatment facility. When service members leave active duty, they’re eligible for either VA or TRICARE coverage, depending on how they separated from military duty.
Veterans Community Care Programs
VA offers 3 types of programs that provide non-VA community care to veterans. They are Patient-Centered Community Care (PC3), Community Care Network (CCN), and Veterans Care Agreements (VCA). The second, CCN, consolidates 2 existing VA community care programs—Patient-Centered Community Care and Veterans Choice—as called for by the VA MISSION Act of 2018, which sought to eliminate the confusion veterans have faced with multiple programs and eligibility requirements, helping to ensure that veterans get the right care at the right time from the right provider.
Generally, a veteran eligible for non-VA community care may schedule an appointment with a VA health care provider or seek VA's authorization to receive hospital care, medical services (including rehabilitation), or extended care services from an eligible entity or provider—as long as VA has determined the care or services are clinically necessary.
Read more about the 3 VA community care programs, including recent changes and how to sign up.
For more information about PC3, CCN, and VCA, and to stay up-to-date on these programs, see the following resources:
APTA Partnering With VA
APTA and VA are partners under a memorandum of agreement (MOA) to leverage the strengths of both organizations for the good of veterans, physical therapists, and physical therapist assistants. In particular, the 2 organizations are working together to raise awareness of nonpharmacological treatment options for pain, VA’s efforts toward preventing suicide among this vulnerable population, the National Veterans Sports Programs and Special Events, and the VA Adaptive Sports Grants Program. Read more about the MOA.
Additional Veterans Affairs Resources
The TRICARE program is administered by 2 separate contractors in 2 different regions: the East Region is administered by Humana Military. The West Region is administered by Health Net Federal Services.
PTAs and TRICARE: Update
June 6, 2018: The National Defense Authorization Act of 2017, signed on December 12, included a provision adding PTAs (and OTAs) as authorized providers under TRICARE. However, this change is not yet effective. The change to regulation will be implemented through the notice and comment rulemaking process. The proposed rule is expected in the fall of 2018 or spring of 2019. A 60-day comment period will follow the release of the proposed rule, after which the Department of Defense will review the comments and draft and publish the final rule.
Until the rule is finalized and published, TRICARE does not consider a PTA as an authorized provider, and the rule will not be retroactive.
APTA will keep members informed of the timeline for this changeover to the TRICARE system.
||Proposed rule to implement the law is under coordination by Department of Defense (DoD)
||Proposed rule is released to the Office of Management and Budget (OMB) for review
|December 20, 2018
||Proposed rule is published in Federal Register for public comment
|+ 60 days
||Public comment period ends
|+ 30-90 days
||Draft of final rule is sent to DoD after Defense Health Agency addresses comments for potential revisions
|+ 45-60 days
||Final rule is cleared by DoD and White House staff and released to OMB for review
||Final rule is published in Federal Register
(by 2021 per
Additional TRICARE Resources
- APTA Managed Care Contracting Toolkit
This can be a helpful resource when contracting with managed care contractors such as those that administer TRICARE.
- TRICARE Information for Providers
The TRICARE website offers general information on rates and reimbursement.
- TRICARE Program Manuals (2015 Edition)
These manuals are applicable to the east and west regional managed care support contractors.
- TRICARE Allowable Charges Tool
This interactive tool allows you to enter a zip code to find the maximum charges TRICARE is allowed to pay for the most frequently used procedures or services in a specific geographic area. These charges are tied by law to Medicare's allowable charges, and they do not reflect TRICARE beneficiary out-of-pocket cost shares, copayments, deductibles, or payments made by any other health plan coverages.