. Group Retiree plans may have different copays and coinsurance. Some groups may have different frequency for preventive services (per contract year instead of per calendar year). A copay applies for any care received for a medical condition that’s treated or monitored during a preventive visit. Does TRICARE For Life cover physical therapy? A: Once Medicare reaches the maximum they will pay for the year TRICARE For Life will consider as the primary payer. MD orders, progress notes, etc. May be requested to determine medical necessity. Physical therapy helps you gain greater self-sufficiency, mobility, and productivity through exercises and other modalities intended to improve muscle strength, joint motion, coordination, and endurance. TRICARE doesn't cover the physical therapy services below. This list isn't all inclusive.

• Copayments and cost-shares are subject to change at the beginning of each calendar year.
  • Copayments are per occurrence or per visit.
  • Cost-shares are a percentage of the contracted rate for network providers and the maximum TRICARE allowable for non-network providers on certain types of services.
• Beneficiaries have an out-of-pocket maximum for covered medical expenses; this is known as the catastrophic cap.
• Point of Service cost-shares and deductibles may apply to TRICARE Prime and TRICARE Prime Remote beneficiaries (excluding active duty service members).

Important Note: Active duty service members do not have any out-of-pocket costs for care.

2021 Costs

2021 Cost Information by Benefit

Detailed information on copayments and cost-shares is listed below by benefit. You can also view this information using the cost links in our Benefits A-Z list.

Maintenance of Wakefulness Testing (MWT)

Maintenance of wakefulness testing for obstructive sleep apnea is a limited benefit for active duty service members only. More >>

Mammogram

One screening mammogram every 12 months is covered for women with no symptoms beginning at age 40. Women with a high risk of breast cancer may receive a screening mammogram beginning at age 30. More>>

Massage Therapy

Massage therapy and services by a massage therapist are not a covered benefit. Physical therapy that is medically necessary is a covered benefit when performed by a TRICARE-authorized physical or occupational therapist. Physical therapy may include massage procedures.

Mastectomy

A mastectomy is a covered benefit when medically necessary as a treatment for breast cancer. A prophylactic mastectomy is a limited benefit. More >>

Mastectomy Bras

Mastectomy bras are considered medical supply items and are covered in lieu of reconstructive surgery or when reconstruction surgery has failed. TRICARE allows two per calendar year.
Cost Information

Maternity Care

Maternity care is a covered benefit. Global maternity care includes prenatal care from the first obstetric (OB) visit, labor and delivery, postpartum care for up to six weeks after the birth of the child, and treatment of complications. More >>

Maternity Ultrasounds

Maternity ultrasounds that are medically necessary are a covered benefit. Routine ultrasounds and ultrasounds to determine gender are not covered. More >>

Medical or Surgical Error

Services or hospitalizations as a result of a medical or surgical error are not a covered benefit.

Medication Assisted Treatment (MAT)

Medication assisted treatment (MAT) is a covered benefit for the treatment of opioid use disorders. More>>

Medication Management

Psychotropic pharmacologic (medication) management is a covered benefit. More>>

Medication or Pharmaceuticals

Medication or pharmaceuticals may be covered for those conditions that are approved by the Food and Drug Administration (FDA). Medication or pharmaceuticals for off-label use may covered if the drug is FDA approved and the off-label use is medically necessary, supported by medical literature identified by the contractor, which indicates the drug is nationally accepted as standard practice, and is not otherwise excluded.

Mental Health

Mental health care is a covered benefit. More >>

Midwife Services

Tricare Prime Physical Therapy Copay

Midwife services provided by a Certified Nurse Midwife (CNM) are a covered benefit. The CNM must be certified by the American Midwifery Certification Board and state licensed when required by the state. Midwife services by a Registered Nurse who is not a CNM may be covered with a physician referral and supervision. Midwife services by a lay midwife, Certified Professional Midwife (CPM) or Certified Midwife (CM) are not a covered benefit. See maternity care.

Migraine Treatment

Specific services/procedures are not a covered benefit. More >>

Tricare Select Physical Therapy Cost

Milk (Banked Donor)

Banked donor milk is a limited benefit. More >>

Mucus Clearing Devices

Tricare Office Visit Copay

Mucus clearing devices may be covered for diseases including, but not limited to, cystic fibrosis, chronic obstructive pulmonary disease, chronic bronchitis, and emphysema. These devices also may also be covered for beneficiaries who have impaired ability to clear secretions.