Outpatient Mental Health Care Referral Requirements
Wednesday, May 11, 2022
TRICARE covers a variety of outpatient mental health and substance use disorder office visits when medically or psychologically necessary. When being seen by a network provider, most TRICARE beneficiaries do not require a referral for these services. Lately, Health Net Federal Services, LLC (HNFS) has noticed an increase in referral requests for outpatient mental health care. We ask you please review the referral requirements below. Your understanding of these guidelines can help ensure beneficiaries get needed mental health care in a timely manner.
Active duty service members
Active duty service members (ADSMs) are the only beneficiaries who require a referral from their primary care manager and prior authorization for all civilian mental health services. The only exception to this is for services authorized under Military OneSource.
All other TRICARE beneficiaries
- Non-ADSMs enrolled in TRICARE Prime do not require an approval from HNFS when seeing a network provider for outpatient mental health office visits. TRICARE Prime beneficiaries must have an approval from HNFS to see a non-network provider, or they can use the Point-of-Service option.
- TRICARE Select beneficiaries do not require an approval from HNFS for outpatient mental health care. We encourage use of network providers to save on out-of-pocket costs.
- The following services always require prior authorization for all TRICARE beneficiaries: psychoanalysis, electroconvulsive therapy, transcranial magnetic stimulation, and Spravato®.
Using the Prior Authorization, Referral and Benefit Tool
Did you know HNFS’ Prior Authorization, Referral and Benefit Tool allows you to check whether a prior authorization or a referral is needed? Save yourself and your patients time by first checking to see if approval is required.
For more information on TRICARE’s mental health care benefits, what services are covered (or not covered) and what the approval requirements are, visit our Mental Health benefits page.