TRICARE Covers School Physicals

 
Both public and private schools in the United States may require children to have comprehensive physical examinations before enrolling. Health care providers play a key role in informing and advising parents and guardians of medical requirements for school-aged children.
 
TRICARE covers physicals that are required for school enrollment for children ages 5–11. However, TRICARE does not cover physicals for children outside of this age range, even if the examinations are required for school enrollment. Additionally, TRICARE does not cover physicals required for children of any age to participate in sports.
 
School systems require physical examinations to ensure that children are in good health and have received the proper immunizations. These exams also help screen potential health problems and risks that may affect students and their families, as well as school faculty and staff. In most cases, the physical must be completed before the child enters kindergarten or the first year of school. Parents and guardians may need to provide the school with a copy of the physical-examination report or with a letter from the health care provider confirming that the examination was administered during a specified time period. Standard office-visit evaluation and management Current Procedural Terminology (CPT®) codes (99201–99205 and 99211–99214) apply for covered school physicals. However, health care providers should be aware that payments for covered school physicals may not exceed what would have otherwise been reimbursed for comprehensive preventive medicine services (CPT codes 99383 and 99393).