Accessible Outpatient Mental Health Care is Available for Your TRICARE Patients
Wednesday, May 15, 2024
May is Mental Health Awareness Month. As a health care provider, you play a critical role in ensuring your patients get the mental health help they need. Encourage patients to use TRICARE’s mental health benefit, which allows for outpatient mental health services, such as psychotherapy, and telemental health that is medically or psychologically necessary to treat a covered mental health disorder. This includes any combination of individual, family, collateral or group sessions.
Did you know most TRICARE beneficiaries can self-refer for outpatient mental health care/telemental health care without a referral? We appreciate your support in seeing patients without delay.
When is a referral not required?
- TRICARE-certified mental health counselors (TCMHCs) can see most TRICARE patients without a referral and without physician oversight. There are exceptions for active duty service members (ADSM). See below.
- TRICARE Prime beneficiaries (excluding ADSMs) who see network providers do not need a referral. TRICARE Prime patients who see non-network providers without an HNFS-approved referral are subject to point-of-service fees.
- TRICARE Select beneficiaries do not require an approval from HNFS.
When is a referral and/or physician oversight required?
- 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.
- For these providers, if a TRICARE patient self-refers for care, you must get a written physician referral (also known as a script) prior to rendering services. The referring physician must agree to provide oversight of the treatment. You do not need to submit a separate referral request to HNFS for approval.
- When submitting claims, you must include the referring physician’s name and National Provider Identifier (NPI) in order to be eligible for reimbursement.
- 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.
For more information on TRICARE’s mental health and telemental health benefits, visit our Mental Health benefits page.
