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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Tricare West

Coverage is based on the beneficiary’s medical needs and generally limited to 24 visits within a 60-day period. The number of visits authorized indicates the actual number of visits, not the individual units per CPT® code.

Prior Authorization

PT/OT/ST requires prior authorization for TRICARE Prime

Prior authorization is not required for TRICARE Select beneficiaries, however, a physician’s order is required for claims processing.

Services Not Covered

    • Physical therapy services performed by a physical therapy assistant
    • Physical therapy services for the following:
    • Diathermy, ultrasound and heat treatments for pulmonary conditions
    • General exercise programs
    • Separate charges for instruction of the patient and family in therapy procedures
    • Repetitive exercise to improve gait, maintain strength and endurance, and assistive walking such as that provided in support of feeble or unstable patients
    • Range of motion and passive exercises, which are not related to restoration of a specific loss of function
    • Maintenance therapy that does not require a skilled level of assistance
    • Vocational assessment and training or assessments to determine status of disability
    • Athletic training evaluation (CPT® 97169–97172)
    • CPT® 97532 or 97533 when used to improve cognitive function as a result of neuronal growth through the repetitive exercise of neuronal circuits
    • CPT® 97532 or 97533 for sensory integration training
    • Services provided to address disorders or conditions resulting from occupational deficits
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