To link directly to this toolkit from your websites, use this link: [Health.mil/LowBackPainToolkit].
TRICARE’s Low Back Pain and Physical Therapy Demonstration waives cost-shares for up to three covered physical therapy sessions for eligible beneficiaries. After the third covered physical therapy session, beneficiaries will pay regular cost-shares and copayments.
The demonstration runs from Jan. 1, 2021 through Dec. 31, 2023. TRICARE may terminate or extend the demonstration.
The waived cost-shares don’t apply towards the annual deductible.
Who’s Eligible?
Beneficiaries must reside in and receive care in one of the following states:
- Arizona
- California
- Colorado
- Florida
- Georgia
- Kentucky
- North Carolina
- Ohio
- Tennessee
- Virginia
Beneficiaries aren’t eligible for this demonstration if they’re:
- Located overseas
- Enrolled in the Continued Health Benefit Program
- Enrolled in the US Family Health Plan, or
- Receiving care from a Medicare-certified home health agency
How it Works
A beneficiary must:
- Live in and seek care in one of the 10 demonstration states
- Have a new primary diagnosis of low back pain. The diagnosis must be made after the demonstration starts. If their diagnosis is from before Jan. 1, 2021, they aren’t eligible for this demonstration.
- Have a referral from a TRICARE-authorized provider. The referral must be to an in-network TRICARE-authorized provider.
- Beneficiaries using TRICARE For Life will only need to see a TRICARE-authorized provider.
After the third covered physical therapy session with a waived cost-share, beneficiaries will be responsible for standard cost-shares for future covered sessions.
What is a TRICARE demonstration?
A demonstration is a special provision that lets TRICARE try new methods of delivering health care. It also gives financial relief to a certain population. After the demonstration, the service may or may not become a TRICARE covered service.
Approved Graphics
We’ve developed this digital toolkit to give you graphics you can use locally on your digital and social media platforms. Use the materials provided in this toolkit to help educate and empower eligible beneficiaries to participate in TRICARE’s low back pain and physical therapy demonstration.