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Physician Referral Requirement for Supervised Mental Health Counselors

Tuesday, July 30, 2019

TRICARE’s mental health benefit allows for outpatient mental health, also known as psychotherapy, that is medically or psychologically necessary to treat a covered mental health disorder. This includes any combination of individual, family, collateral or group sessions.

Although most TRICARE beneficiaries can self-refer for outpatient mental health care (see below), all care received from supervised mental health counselors, supervised licensed pastoral counselors and supervised licensed professional counselors must be ordered and supervised by a physician (MD or DO) to be covered under TRICARE. 

If you are a supervised mental health counselor, supervised licensed pastoral counselor or supervised licensed professional counselor and a TRICARE patient self-refers to you for care, he or she must have a written physician referral (also known as a script) prior to you rendering services. In addition, the referring physician must agree to provide oversight of the treatment. Please refer to TRICARE Policy Manual, Chapter 11, Section 3.11.

When submitting claims, you must include the referring physician’s name and National Provider Identifier (NPI) in order to be eligible for reimbursement.   

Outpatient mental health care referral requirements:

  • Active duty service members (ADSMs) must have a referral from their primary care provider approved by HNFS for all civilian mental health services, except for services authorized under Military OneSource.
  • TRICARE Prime beneficiaries (excluding ADSMs) do not require HNFS approval when seeing a network provider; however, services from non-network providers without HNFS approval are subject to Point of Service fees. 
  • TRICARE Select beneficiaries do not require an approval from HNFS.