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They're here: Crucial details on the ins and outs of a TRICARE project that waives cost-sharing for up to three physical therapy sessions for patients with low back pain are now available. The recently updated guidance includes, among other information, the list of eligible diagnosis codes to be used in the 10-state demonstration project.

What's New

On Oct. 27, the Military Health System, which oversees the TRICARE health insurance system used throughout the U.S. military, published updates to its TRICARE operations manual — including changes to chapter 18, section 9, the passages that detail how the LBP demonstration project will work.

The finalized guidance clarifies that the program is designed for used by TRICARE Prime, TRICARE Select, and TRICARE For Life beneficiaries with LBP who are prescribed or referred to a TRICARE-authorized provider. The manual now also lists the 85 ICD-10 codes that will be accepted as primary diagnoses.

Basics of the Demonstration

The TRICARE demonstration is aimed at incentivizing physical therapist services for patients with LBP to decrease the use of more costly, low-value testing and interventions such as imaging, surgery, and opioids; reduce the overall cost of managing LBP; and improve patient outcomes. The project is limited to beneficiaries and providers in Arizona, California, Colorado, Florida, Georgia, Kentucky, North Carolina, Ohio, Tennessee, and Virginia, but if it's successful, the Department of Defense may expand it to the entire TRICARE population.

Qualified patients in the project states will be able to access up to three physical therapy sessions with no cost-sharing requirement.

APTA's Guide to the Project

Looking for insight on how to make the most of the TRICARE opportunity? We've published an online guide that outlines requirements, offers tips for compliance, and provides links to relevant TRICARE and practice resources.

Getting the Message to Patients and Referrers

Even though the TRICARE manual says the system will educate beneficiaries and providers on the demonstration project, it never hurts to be ready with your own consumer-focused information. That's where APTA's consumer website comes in.

APTA's consumer-focused, easy-to-understand explanation of the TRICARE demonstration breaks down qualifications for the program and explains how physical therapy can help with LBP.

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