Back to Top Skip to main content

Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Policy Manual 6010.60-M, April 1, 2015
Providers
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)
Revision:  
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).
2.0  POLICY
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.
3.0  EXCLUSION
Any services provided prior to examination and subsequent referral by a physician.
- END -

Utility Navigation Links

DoD Seal

tricare.mil is the offical website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help Resources page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.

v4.5.7082.22297

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.