Low Back Pain and Physical Therapy Demonstration

The 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, you’ll pay regular cost-shares and copayments.

• The demonstration runs from Jan. 1, 2021 through Dec. 31, 2023. TRICARE may terminate or extend the demo.
• The waived cost-shares don’t apply towards your annual deductible.
• If you’re enrolled in TRICARE Prime, your point-of-service fees won’t be waived.

Who’s Eligible?

You must reside in and receive care in one of the following states:

• Arizona
• California
• Colorado
• Florida
• Georgia
• Kentucky
• North Carolina
• Ohio
• Tennessee
• Virginia

You aren’t eligible for this demonstration if you’re:

• Located overseas
• Enrolled in the Continued Health Care Benefit Program
• Enrolled in the US Family Health Plan, or
• Receiving care from a Medicare-certified home health agency

How it Works

You must have:

• A new primary diagnosis of low back pain. Your diagnosis must be made after the demonstration starts. If your diagnosis is from before Jan. 1, 2021, you aren’t eligible for this demo.
• A referral from a TRICARE-authorized providerAn authorized provider is any individual, institution/organization, or supplier that is licensed by a state, accredited by national organization, or meets other standards of the medical community, and is certified to provide benefits under TRICARE. There are two types of TRICARE-authorized providers: Network and Non-Network. DS. Your referral must be to an in-network TRICARE-authorized provider.
  • If you’re using TRICARE For Life, you’ll only need to see a TRICARE-authorized provider.