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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 11
Section 3.1
Physician Referral And Supervision
Issue Date:  December 18, 1985
Authority:  32 CFR 199.6(c)(3)(iii)(K), (c)(3)(iv); and 10 USC 1079(a)
1.0  ISSUE
1.1  In order to be considered for benefits on a fee-for-service basis, the services of the following individual professional providers of care may be provided only if the beneficiary/patient is referred by a physician for the treatment of a medically-diagnosed condition.
1.2  A physician must also provide continuing and ongoing oversight and supervision of the program or episode of treatment provided by the following individual providers:
•  Licensed Registered Nurses (RNs).
•  Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN).
•  Audiologist.
•  Pastoral Counselors.
•  Supervised Mental Health Counselors (SMHCs).
2.1  A physician must establish a diagnosis which, in order to be considered for benefits, must describe a covered condition. This means the physician must actually see the patient, do an evaluation and arrive at an initial diagnostic impression prior to referring the patient. Any change in the referral diagnosis must be coordinated with the referring physician.
2.2  The overall management of the patient rests with the physician and, in order to assure appropriate case management, coordination must be made with the referring physician on an ongoing basis. Physician supervision means the physician provides overall medical management of the case. The referring physician does not have to be physically located on the premises of the provider to whom the referral is made. Communication back to the referring physician is an indication of medical management.
2.3  Military physicians may refer patients to civilian providers. Because of the mobility of military physicians due to transfers, retirements and discharges, if the original referring physician has relocated, another military physician may assume responsibility for the case upon review of the Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM) clinical record, a narrative of the patient’s present status and the proposed treatment plan.
Any services provided prior to examination and subsequent referral by a physician.
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