TRICARE physical therapy coverage: codes, limits and referrals
The short answerTRICARE covers physical therapy by a licensed PT and excludes maintenance therapy and general exercise programs. In the West Region, a claim needs a PCM referral, the referring provider on the claim, or faxed orders. Other regions may differ.
By Javier Alvarez · Updated · 1 min read
1 row: TRICARE. Public policy, not the member's benefits.
TRICARE
TRICARE outpatient physical therapy (billing detail is TRICARE West Region) · All states
| 97110 | Listed (inside the PT procedure ranges in the West Region billing guide.) [1] |
|---|---|
| 97112 | Listed (inside the PT procedure ranges in the West Region billing guide.) [1] |
| 97140 | Listed (inside the PT procedure ranges in the West Region billing guide.) [1] |
| 97161 | Listed (inside the PT procedure ranges in the West Region billing guide.) [1] |
| 97162 | Listed (inside the PT procedure ranges in the West Region billing guide.) [1] |
| 97163 | Listed (inside the PT procedure ranges in the West Region billing guide.) [1] |
| 97164 | Listed (inside the PT procedure ranges in the West Region billing guide.) [1] |
| 97530 | Listed (inside the PT procedure ranges in the West Region billing guide.) [1] |
| 97750 | Listed (inside the PT procedure ranges in the West Region billing guide.) [1] |
| Where it applies | TRICARE covers physical therapy provided by a licensed physical therapist, or a PT assistant under the supervision of a TRICARE-authorized PT, to aid recovery from disease or injury. [2] |
| Other codes | The West Region guide lists the physical therapy procedure ranges 97010 to 97530 and 97542 to 97750, among others. Orders can come from a physician, PA, NP or podiatrist. [1] |
| Visit limits | TRICARE does not cover several PT services, including general exercise programs and maintenance therapy. Its list is not all inclusive, and it tells providers to contact their regional contractor for specific limits. [2] |
| Referral | In the West Region, every therapy claim must meet one of three conditions: a PCM referral with TriWest approval, the referring provider listed on the claim, or physician orders faxed or mailed to PGBA. The guide recommends listing the referring provider to avoid payment delays. [1] |
| Also | The TriWest guide covers the West Region only. The East Region contractor, Humana Military, was not checked. [1] |
- TriWest (TRICARE West Region): Billing for Physical, Occupational, and Speech Therapies Criteria QRG (Aug 26, 2026, PDF), checked October 30, 2026
- TRICARE: Physical Therapy, covered services (updated 10/1/2026), checked October 30, 2026
What TRICARE's documents say
The table above has every field we found for TRICARE, with numbered sources. In short:
- Visit limits. TRICARE does not cover several PT services, including general exercise programs and maintenance therapy. Its list is not all inclusive, and it tells providers to contact their regional contractor for specific limits.
- Where it applies. TRICARE covers physical therapy provided by a licensed physical therapist, or a PT assistant under the supervision of a TRICARE-authorized PT, to aid recovery from disease or injury.
- Codes. 97110, 97112, 97140, 97161, 97162, 97163, 97164, 97530 and 97750 are listed.
Physical therapy coverage at other national payers
Medicare, UnitedHealthcare Medicare Advantage, UnitedHealthcare Commercial, Aetna, Cigna and Humana.
Check TRICARE's claim against the row
Before the claim goes out, compare it with the row above: the evaluation code matches the complexity you documented, the timed codes fit the minutes, any prior authorization covers the visit, and the plan of care is signed when the payer asks for it. The physical therapy table compares TRICARE with every other payer we checked.