Podiatrists May Now Refer Patients for Physical or Occupational Therapy

Thursday, August 19, 2021

TRICARE recently updated its policy on which provider types can prescribe physical or occupational therapy (PT or OT) for beneficiaries. Implemented on July 16, 2021, with a retroactive date of Dec. 17, 2020, podiatrists may now prescribe PT or OT within the scope of their license.

Please review the following referral requirements based on TRICARE plan type:

TRICARE Prime: Previously, podiatrists who deemed PT or OT as an appropriate course of treatment for their TRICARE Prime patients had to coordinate with the beneficiary’s primary care manager (PCM), as a PCM referral was required. While a specialty referral to the podiatrist remains required for TRICARE Prime patients, a subsequent referral from the PCM for PT or OT prescribed by that podiatrist is not required. Only the PT/OT order from the podiatrist is needed for claims processing. Rendering physical and occupational therapists should indicate who the referring podiatrist is in Box 17 of the 1500 claim form.
TRICARE Select: No referral is required for podiatry, PT or OT services for patients enrolled to TRICARE Select. However, the podiatrist’s order for PT or OT is needed for claims processing. Rendering physical and occupational therapists should indicate who the referring podiatrist is in Box 17 of the 1500 claim form.

As a reminder, coverage for PT and OT is based on the beneficiary's medical needs. The number of visits authorized indicates the actual number of visits, not the individual units per CPT® code. The following baselines will be used as a guide for the number of visits and duration of approval:

Acute injuries (for example, fractures, sprains, or Achilles tendinitis) = 12 visits with a duration of 120 days
Post-operative care (for example, fracture reductions, tendon or ligament repair, or metatarsal surgery) = 24 visits with a duration of 150 days
Long term conditions (for example, Achilles tendinitis, heel spurs, or plantar fasciitis) = 72 visits with a duration of 180 days

Find more information on our Physical Therapy and Occupational Therapy benefits pages.