Referrals from psychologists and psychiatrists

This guide is for pediatric and adult OT, PT and SLP practices that receive referrals from psychologists, psychiatrists and other mental-health clinicians. Build each partnership around the referral question, not the diagnosis: confirm the question sits in your discipline’s scope, check who consents and what the payer requires, then answer the question in a clinician-written update.

A psychiatric diagnosis does not by itself establish a need for occupational therapy, physical therapy or speech-language therapy. Materials aimed at these referrers should never suggest that therapy replaces mental-health treatment, and children and adults need separate pathways for consent, communication and payment.

Why do psychologists and psychiatrists refer to OT, PT and SLP?

They refer when they see a problem in daily activities, communication or movement that sits outside their own treatment and inside another discipline’s scope. The referral asks a therapist to look at that problem, not to take over the mental-health care.

The referrer’s profession shapes the paperwork. A psychiatrist is a medical doctor (MD or DO) who specializes in mental health and can prescribe medication.⁠¹¹ Psychologists, neuropsychologists, social workers and counselors are not physicians, which matters for Medicare’s plan of care rule below.

What does a mental-health referral ask a therapist to assess?

It asks a functional question: what the person cannot do, or does with difficulty, in daily life, communication or movement, and what the referrer needs to know about it. "Please evaluate and treat" with a diagnosis code is a request, not a question. Before scheduling, turn it into one the evaluating clinician can answer.

These are examples, not a menu to advertise; the specialty guide covers deciding which your clinicians can answer.

Why doesn’t a psychiatric diagnosis justify therapy on its own?

Because a diagnosis names a condition, while OT, PT and SLP services answer to function and to goals set at evaluation. Medicare’s plan of treatment prescribes the type, amount, frequency and duration of services and indicates the diagnosis and anticipated goals.⁠¹³ ASHA’s Code of Ethics tells certified SLPs to provide services only when benefit can reasonably be expected, and APTA’s code asks PTs to judge within their scope and to refer when necessary.⁠^1,14

So an evaluation can end in services with goals, a referral elsewhere, or no therapy now; tell referrers at the start that all three are normal answers.

Which decisions does a mental-health referral partnership need?

Six, each with an owner and a written result; settle the standing ones once with each referrer and apply them to every referral.

Outreach basics for any referral source, such as choosing contacts and a one-page service sheet, are in the pediatrician referral guide and the adult referral guide.

What does occupational therapy offer in mental-health referrals?

OT answers how a mental-health condition affects what a person does every day: self-care, routines, school or work tasks, home management, leisure and social participation. AOTA describes occupational therapy as helping people manage physical and mental health needs, develop healthy daily routines and learn strategies to navigate the stresses of life, and states that OT practitioners provide mental health services in communities, hospitals, schools, clinics, homes and other places where people carry out their daily activities.⁠²

AOTA’s account of the work is functional: activity-based interventions designed to develop coping skills, improve day-to-day independent living skills and build functional capacity, and in outpatient clinics, skills to identify environmental triggers and build resilience.⁠^15,16 For a child or teen, the question can concern getting ready for school, homework or play; for an adult, self-care, managing a home, returning to work or rebuilding a weekly routine.

Keep the boundary explicit. AOTA lists roles OT practitioners have the skills to hold, including qualified mental health professional, but an occupational therapist’s scope of practice is defined in state law.⁠^2,17 In a referral from a psychologist, the OT answers the occupational question and the psychotherapy stays with the referrer. A pediatric practice that also offers sensory or developmental services should describe them separately, so a referrer does not read them as a mental-health program.

What does speech-language pathology cover in these referrals?

SLP answers questions about communication and the thinking that supports it. ASHA’s Scope of Practice defines communication to include speech production and fluency, language, cognition, voice, resonance and hearing; it lists pragmatics, the social aspects of communication, under language, and attention, memory, problem solving and executive functioning under cognition.⁠³

Three kinds of referral question follow:

• Social communication. ASHA notes that social communication disorder can affect social participation, relationships, academic success and performance on the job, and that it cannot be diagnosed together with autism spectrum disorder.⁠¹⁸
• Selective mutism. ASHA describes SLPs as integral team members who often collaborate with psychologists and psychiatrists, because selective mutism is an anxiety-based disorder that can significantly affect access to speech and language skills.⁠¹⁹
• Cognitive-communication. A neuropsychologist’s question about attention, memory or problem solving in conversation, class or work sits in the cognition domain of the same scope.⁠³

The boundary is in the scope too: SLPs diagnose communication and swallowing disorders but not medical conditions, address negative emotions and thoughts related to communication disorders, and refer to other professionals when counseling needs fall outside communication and feeding and swallowing.⁠³ So an SLP can work with a child’s frustration at not being understood while the anxiety stays with the psychologist.

Where does physical therapy fit in mental-health referrals?

PT fits through a movement or physical-health question, a narrower opening than OT’s or SLP’s, and a PT practice should say so to referrers rather than stretch its service list. APTA’s House of Delegates position states that PT services include the prevention and management of behavioral and mental health conditions, addressing the interconnected physical, psychological and social health domains, and calls interprofessional collaboration the standard of care.⁠⁴

The question a PT answers for a mental-health referrer is about the body: for adults, pain that limits activity, low activity tolerance, balance and fear of falling, or a supervised exercise plan; for children and teens, gross motor coordination, a return to sport or play, or pain. APTA’s Code of Ethics asks PTs to make judgments within their scope of practice and expertise and to communicate with, collaborate with or refer to other professionals when necessary.⁠¹⁴

Who consents and who hears back when the patient is a child or an adult?

For an adult, the patient decides, and family take part with the patient’s agreement or under legal authority; for a minor, parents usually decide, but state law can let a teenager consent to some care alone. Settle which applies before the first call.

Adults. HIPAA lets a covered provider share information relevant to a family member’s involvement in care, after the patient, if present and capable, agrees or has the chance to object.⁠²⁰ A relative is a personal representative only with legal authority to make health care decisions, such as a health care power of attorney or a guardianship.⁠⁸

Children and teens. HHS states that parents of minor children, typically under age 18, are generally their personal representatives, and that state law addresses the age at which a minor may consent to certain types of health care and may add requirements for disclosing a minor’s information to parents.⁠⁷ A parent is not the personal representative when the minor lawfully consents to a service needing no parental consent, when a court or another authorized person consents, or when the parent agrees to a confidential relationship between the minor and the provider; HHS’s own example is a state law letting an adolescent obtain mental health treatment without parental consent.⁠⁸

So ask the referrer who consented to a teenager’s mental-health care and whether a confidentiality agreement covers it. The therapy evaluation may still need a parent’s consent; your state’s law decides, so settle it with your compliance adviser rather than applying one rule to every family. For a teen who turns 18 during treatment, see the pediatric-to-adult transition guide.

What can HIPAA let you share with a referring psychologist?

HIPAA lets a covered practice share health information with the referrer for treatment without the patient’s authorization, because treatment includes coordination, consultation between providers and referral from one provider to another.⁠⁵ A covered entity may disclose for the treatment activities of any health care provider, including providers not covered by the Privacy Rule, and the minimum necessary standard does not apply to disclosures to a provider for treatment.⁠^5,21

Four limits apply:

• Psychotherapy notes need the patient’s authorization.⁠⁶
• A state privacy law more stringent than HIPAA is not preempted, so a stricter state rule on mental-health or minors’ records applies on top.⁠²²
• You need not agree to a patient’s request to restrict what goes to the referrer, but you are bound by any restriction you accept.⁠⁵
• Treatment disclosures must be consistent with your notice of privacy practices, so say there, and at intake, that reports go back to referring providers; the new patient email templates are a place to put it.⁠⁵

What are psychotherapy notes, and should a therapist ask for them?

No, because what a therapy evaluation needs sits outside them. Psychotherapy notes are a mental health professional’s notes on the contents of a counseling session, kept separate from the record; the definition excludes medication prescription and monitoring, session times, results of clinical tests, and any summary of diagnosis, functional status, treatment plan, symptoms, prognosis and progress.⁠²³ Disclosing them requires the patient’s authorization, with narrow exceptions.⁠⁶ The excluded items are what a referral needs, so ask for those by name and word your referral form so nobody attaches session notes.

Do substance use disorder records follow a different privacy rule?

Yes, when they come from a Part 2 program: a federally assisted program that holds itself out as providing, and provides, substance use disorder diagnosis, treatment or referral for treatment.⁠^7,24 A disclosure made with the patient’s written consent arrives with a written Part 2 notice and a copy or explanation of the consent; the longer notice bars using the record in proceedings against the patient without consent or a court order, lists when further use is allowed, including by a covered entity that received it for treatment, and says a general release authorization is not enough to redisclose it.⁠²⁵ Ask whether any records come from an addiction treatment program, and if so keep the notice with them and flag them.

Does a psychologist’s referral meet Medicare’s plan of care rule?

No. Medicare Part B pays for outpatient OT, PT and SLP only under a written plan of treatment certified by a physician, nurse practitioner, clinical nurse specialist or physician assistant, and a psychologist is not one of them.⁠^{9,10,26,27,28} CMS’s manual adds that Medicare has no requirement for an order and that payment depends on certification of the plan rather than the order.⁠⁹

A psychiatrist is a physician, a doctor of medicine or osteopathy, so a psychiatrist who knows the case can certify, and a psychiatric nurse practitioner can as a nurse practitioner where state law permits.⁠^9,10,11 When the therapist establishes the plan, a signed certification is not needed if the record holds a written order or referral from the patient’s physician, NP, PA or CNS and the plan was delivered to that practitioner within 30 days of completing the initial evaluation; a psychologist’s referral does not qualify.⁠¹⁰ Recertification is required at least every 90 days.⁠¹⁰

So when a psychologist refers a Medicare patient, ask at intake who the patient’s physician or nurse practitioner is, and with the patient’s agreement send the plan to that practitioner as soon as it is written; CMS warns that payment may be denied if the plan is not certified.⁠⁹ The credentialing guide covers the enrollment that comes first.

What do Medicaid and commercial plans require for these referrals?

Their own rules, found in each plan’s contract or provider manual: check whether it requires a physician’s order, a primary care referral or prior authorization, and whether it accepts a psychologist as the referrer. State licensing is a separate layer. APTA reports that as of July 1, 2025, all 50 states, Washington, DC and the U.S. Virgin Islands have provisional or unrestricted direct access to PT, while some provisions tied to treatment without a referral persist in a number of states.⁠²⁹ Direct access does not change a payer’s rules, as Medicare’s certification requirement shows.⁠¹⁰ OT scope of practice is defined in state law, and ASHA reminds SLPs to consider all applicable state and federal requirements, so check your practice act for any referral requirement.⁠^17,19

How should a practice take in a referral from a mental-health clinician?

With a checklist that captures the question, the people, the permissions and the payer before anyone books an evaluation, used alike for psychologists, psychiatrists, counselors and social workers.

1. The referrer. Name, profession, credential, the agreed route for records and updates, and whether the referrer is a physician or nonphysician practitioner for payer purposes.
2. The question. The functional question in the referrer’s words and the discipline it belongs to; if none fits, say so now.
3. The decision-maker. Adult or minor, who consented to the mental-health care, who may consent to the evaluation and receive results, and written proof of any representative’s authority.
4. What the patient knows. Whether the patient or family agreed to the referral, and how they prefer to be contacted.
5. Records to request. A diagnosis summary, relevant test results, functional status and the current treatment plan, not psychotherapy notes.
6. Records with their own rule. Anything from a Part 2 program, and any state restriction your adviser has flagged.
7. Safety information. What the referrer wants your clinicians to know about risk, and an urgent contact.
8. Payer. Coverage, any certification, order or prior authorization requirement, and who certifies.
9. Fit. The evaluating clinician’s review of scope and competence, with the outcome sent to the referrer.
10. The return. What the referrer wants back, by when and to whom.

Keep the referral in your protected clinical system; the intake call script covers a first call with a family.

How do you introduce your practice to mental-health clinicians?

Tell them which questions your clinicians answer, for which ages and settings, what you do not do, and how the answer comes back, in a short message rather than a brochure.

Leave out patient names and case stories, and do not imply exclusivity or offer referrals in return. Families given your name may look the clinic up on DrSensory, a directory families use free to find OT, PT and speech therapy clinics; a paid listing adds the clinic’s own description, specialties, ages and conditions treated. DrSensory does not verify clinical quality, so a listing is a way to be found, not a credential; see the profile guide and pricing.

What should your materials never claim about mental health?

That OT, PT or SLP treats, cures or replaces care for a mental-health condition, unless a clinician has the license, competence and evidence for that exact claim. Under the FTC Act, advertising must be truthful and non-deceptive and advertisers must have evidence to back up their claims; satisfied-customer statements usually are not enough to support a health claim.⁠³⁰ ASHA’s code also requires SLPs to represent a service’s intended purpose accurately.⁠¹ Name the function, not the diagnosis: "OT for daily routines when anxiety gets in the way," not "OT for anxiety"; "PT for pain and activity," not "PT for depression."

Can you offer gifts or reciprocal referrals to a psychologist?

No gifts, meals or payments meant to win or reward referrals. The federal Anti-Kickback Statute prohibits knowingly and willfully paying remuneration to induce or reward referrals of services payable by federal health care programs; remuneration includes anything of value, and the statute covers both payers and recipients.⁠¹² Do not promise referrals back in exchange, and ask your adviser about state rules and any arrangement involving money, space or staff.

How should you report back to the referring clinician?

With a short update, written by the clinician who did the evaluation, that answers the question the referrer asked; a front-desk note that the patient was seen is a status, not an answer. HIPAA permits the update as a treatment disclosure.⁠⁵ Leave out details unrelated to the question and anything under a restriction you agreed to; when a parent also receives the report, check whether state law or a confidentiality agreement keeps any of a teen’s information from them.⁠^5,8

Agree a time for the update with each referrer and keep to it, then send progress at agreed points such as recertification and discharge.

What if the evaluation finds no need for therapy?

Say so plainly, because that answers the referral question, and say what change would justify a new referral. ASHA’s code ties SLP services to a reasonable expectation of benefit and APTA’s asks PTs to refer outside their scope; an OT practice owes the referrer the same candor.⁠^1,14

What should you do if a patient raises a safety concern in a session?

Follow a written plan agreed with the referrer before the first patient arrives: whom the clinician calls, in what order, and what the patient is told, so nobody improvises when a patient mentions self-harm or a risk to someone else.

• Immediate danger. Call 911.
• The 988 Lifeline. SAMHSA’s 988 Suicide and Crisis Lifeline offers round-the-clock support for mental health, substance use and more, by text, call or chat.⁠³¹
• The referrer. The urgent contact recorded at intake.
• What HIPAA permits. Disclosure, consistent with law and ethical standards, when the provider believes in good faith it is necessary to prevent or lessen a serious and imminent threat to health or safety and makes it to someone reasonably able to prevent or lessen the threat.⁠³²
• State duties. Your state’s reporting duties for suspected child abuse and threats of harm, learned with your adviser in advance.
• The record. What was said, what the clinician did and whom they contacted, written the same day.

Afterward the clinician returns to the therapy question, and crisis follow-up stays with the referrer and crisis services, consistent with the referral duties in ASHA’s scope and APTA’s code.⁠^3,14

What does a well-run mental-health referral look like in practice?

A question agreed before the evaluation, the right person consenting and a clinician’s answer sent back.

The figures illustrate the method; they are not typical outcomes or recommended frequencies.

What goes in a partnership record for each referring clinician?

One record per referring clinician, kept apart from patient records and free of patient identifiers, holding the agreements that shape every referral; a blank field means the decision is still open.

Review it yearly and whenever either practice changes services, staff or routes.

Sources

1. American Speech-Language-Hearing Association. Code of Ethics (effective March 1, 2023). Checked October 23, 2026.
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   “Individuals shall use every resource, including referral and/or interprofessional collaboration when appropriate, to ensure that quality service is provided.”; “Individuals shall accurately represent the intended purpose of a service, product, or research endeavor”; “Individuals who hold the Certificate of Clinical Competence shall evaluate the effectiveness of services provided, technology employed, and products dispensed, and they shall provide services or dispense products only when benefit can reasonably be expected.”
2. American Occupational Therapy Association. Mental health and well-being (AOTA clinical topic page). Checked October 23, 2026.
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   “Occupational therapy can help clients, groups, and communities to manage physical and mental health needs, develop healthy and effective daily routines to promote well-being, and learn and utilize strategies to navigate the stresses of life.”; “Occupational therapy practitioners provide mental health services in communities, hospitals, schools, clinics, homes, and other places where people carry out their daily activities.”; “Occupational therapy practitioners perform comprehensive and performance-based assessments to evaluate the needs of clients and analyze environmental and contextual factors that influence mental health and wellness.”; “Occupational therapy practitioners have the skills to be licensed community mental health providers, qualified mental health professionals, case managers, care coordinators, group facilitators, program developers, advocates, and consultants.”
3. American Speech-Language-Hearing Association. Scope of Practice in Speech-Language Pathology (2016). Checked October 23, 2026.
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   “Communication includes speech production and fluency, language, cognition, voice, resonance, and hearing.”; “Pragmatics (language use and social aspects of communication)”; “Competent SLPs can diagnose communication and swallowing disorders but do not differentially diagnose medical conditions.”; “discuss, evaluate, and address negative emotions and thoughts related to communication or feeding and swallowing disorders.”; “refer individuals with disorders to other professionals when counseling needs fall outside of those related to (a) communication and (b) feeding and swallowing.”; Cognition is listed as “Attention”, “Memory”, “Problem solving” and “Executive functioning”.
4. American Physical Therapy Association, House of Delegates. The Role of the Physical Therapist and the American Physical Therapy Association in Behavioral and Mental Health (HOD P07-25-49-19, position, last updated October 1, 2025). Checked October 23, 2026.
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   “The American Physical Therapy Association supports interprofessional collaboration as the standard of care in the management of behavioral and mental health conditions.”; “Physical therapist services include the prevention and management of behavioral and mental health conditions, addressing the interconnected physical, psychological, and social health domains to ensure whole-person care.”
5. U.S. Department of Health and Human Services, Office for Civil Rights. Uses and Disclosures for Treatment, Payment, and Health Care Operations (HIPAA Privacy Rule guidance on 45 CFR 164.506). Checked October 23, 2026.
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   Treatment “generally means the provision, coordination, or management of health care and related services among health care providers or by a health care provider with a third party, consultation between health care providers regarding a patient, or the referral of a patient from one health care provider to another.”; “A covered entity may disclose protected health information for the treatment activities of any health care provider (including providers not covered by the Privacy Rule).”; “uses and disclosures of psychotherapy notes for treatment, payment, and health care operations require the individual’s authorization.”; “covered entities are not required to apply the minimum necessary standard to disclosures to or requests by a health care provider for treatment purposes.”; “A covered entity is not required to agree to an individual’s request for a restriction, but is bound by any restrictions to which it agrees.”; “Any use or disclosure of protected health information for treatment, payment, or health care operations must be consistent with the covered entity’s notice of privacy practices.”
6. Office of the Federal Register, Electronic Code of Federal Regulations. 45 CFR 164.508, Uses and disclosures for which an authorization is required. Checked October 23, 2026.
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   §164.508(a)(2): “Notwithstanding any provision of this subpart, other than the transition provisions in § 164.532, a covered entity must obtain an authorization for any use or disclosure of psychotherapy notes, except:”; “(A) Use by the originator of the psychotherapy notes for treatment;”
7. U.S. Department of Health and Human Services, Office for Civil Rights. Information Related to Mental and Behavioral Health, including Opioid Overdose (HIPAA special topics; content last reviewed February 13, 2026). Checked October 23, 2026.
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   “Parents of minor children (typically under age 18) are generally the personal representatives of their children. State law addresses the age at which a minor child may consent to certain types of health care and may contain additional requirements related to disclosing a minor’s health information to parents (or withholding it).”; “The protected health information of individuals who receive substance use disorder treatment in federally assisted programs is subject to additional confidentiality protections under 42 USC 290dd-2 and 42 CFR part 2”.
8. U.S. Department of Health and Human Services, Office for Civil Rights. Personal Representatives (HIPAA Privacy Rule guidance; content last reviewed January 5, 2024). Checked October 23, 2026.
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   For an adult, the personal representative is “A person with legal authority to make health care decisions on behalf of the individual”; “When State or other law does not require the consent of a parent or other person before a minor can obtain a particular health care service, and the minor consents to the health care service;”; “Example: A State law provides an adolescent the right to obtain mental health treatment without the consent of his or her parent, and the adolescent consents to such treatment without the parent’s consent.”; “When someone other than the parent is authorized by law to consent to the provision of a particular health service to a minor and provides such consent;”; “When a parent agrees to a confidential relationship between the minor and a health care provider.”; “the Privacy Rule defers to State or other applicable laws that expressly address the ability of the parent to obtain health information about the minor child.”; “the covered entity may choose not to treat that person as the individual’s personal representative, if in the exercise of professional judgment, doing so would not be in the best interests of the individual.”
9. Centers for Medicare & Medicaid Services. Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Services (Pub. 100-02; table of contents Rev. 13889, issued July 30, 2026), sections 220 to 220.1.3. Checked October 23, 2026.
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   “Although there is no Medicare requirement for an order, when documented in the medical record, an order provides evidence that the patient both needs therapy services and is under the care of a physician.”; “Payment is dependent on the certification of the plan of care rather than the order”; “PHYSICIAN with respect to outpatient rehabilitation therapy services means a doctor of medicine, osteopathy (including an osteopathic practitioner), podiatric medicine, or optometry (for low vision rehabilitation only).”; “NONPHYSICIAN PRACTITIONERS (NPP) means physician assistants, clinical nurse specialists, and nurse practitioners, who may, if state and local laws permit it, and when appropriate rules are followed, provide, certify or supervise therapy services.”; “The provider or supplier (e.g., facility, physician/NPP, or therapist) should obtain certification as soon as possible after the plan of care is established, unless the requirements of delayed certification are met.”; “Since payment may be denied if a physician does not certify the plan, the therapist should forward the plan to the physician as soon as it is established.”
10. Office of the Federal Register, Electronic Code of Federal Regulations. 42 CFR 424.24, Requirements for medical and other health services furnished by providers under Medicare Part B. Checked October 23, 2026.
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    §424.24(c), outpatient physical therapy, occupational therapy, and speech-language pathology services: “The services were furnished while the individual was under the care of a physician, nurse practitioner, clinical nurse specialist, or physician assistant.”; “The initial certification must be obtained as soon as possible after the plan is established.”; “If the plan of treatment is established by a physical therapist, occupational therapist, or speech-language pathologist, the certification must be signed by a physician or by a nurse practitioner, clinical nurse specialist, or physician assistant who has knowledge of the case, except as specified in paragraph (c)(5) of this section.”; “Recertification is required at least every 90 days.”; “If the plan of treatment is established by a physical therapist, occupational therapist, or speech-language pathologist, and there is a written order or referral from the individual’s physician, nurse practitioner (NP), physician assistant (PA), or clinical nurse specialist (CNS) in the patient’s record and the therapist has documented evidence that the plan of treatment has been delivered to the physician, NP, PA, or CNS within 30 days of completion of the initial evaluation, the certification does not need to be signed by a physician, NP, CNS, or PA who has knowledge of the case.”; “No references to an order or referral in this subsection shall be construed to require an order or referral for outpatient physical therapy, occupational therapy, or speech-language pathology services.”
11. American Psychiatric Association. What is Psychiatry?. “A psychiatrist is a medical doctor (an M.D. or D.O.) who specializes in mental health, including substance use disorders.”; “Because they are physicians, psychiatrists can order or perform a full range of medical laboratory and psychological tests”; “psychiatrists can prescribe medications to help treat mental disorders.” Checked October 23, 2026.
12. U.S. Department of Health and Human Services, Office of Inspector General. Fraud & Abuse Laws (A Roadmap for New Physicians). Anti-Kickback Statute, 42 U.S.C. Checked October 23, 2026.
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    § 1320a-7b(b): “The AKS is a criminal law that prohibits the knowing and willful payment of ‘remuneration’ to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs”; “Remuneration includes anything of value and can take many forms besides cash”; “The statute covers the payers of kickbacks-those who offer or pay remuneration- as well as the recipients of kickbacks-those who solicit or receive remuneration.”
13. Office of the Federal Register, Electronic Code of Federal Regulations. 42 CFR 410.61, Plan of treatment requirements for outpatient rehabilitation services. Checked October 23, 2026.
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    “The plan is established before treatment is begun by one of the following:”; “(1) A physician. (2) A physical therapist who furnishes the physical therapy services. (3) A speech-language pathologist who furnishes the speech-language pathology services. (4) An occupational therapist who furnishes the occupational therapy services. (5) A nurse practitioner, a clinical nurse specialist, or a physician assistant.”; “The plan prescribes the type, amount, frequency, and duration of the physical therapy, occupational therapy, or speech-language pathology services to be furnished to the individual, and indicates the diagnosis and anticipated goals.”
14. American Physical Therapy Association. Code of Ethics for the Physical Therapist (House of Delegates). Principle 3C: “Physical therapists shall make judgments within their scope of practice and level of expertise and shall communicate with, collaborate with, or refer to peers or other health care professionals when necessary.” Checked October 23, 2026.
15. American Occupational Therapy Association. Billing and coding occupational therapy for mental and behavioral health services (July 23, 2024; the opening passage is public). Checked October 23, 2026.
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    “Occupational therapy (OT) plays a crucial role in mental health services by helping individuals with mental health challenges engage in meaningful activities, roles, and routines that promote well-being and functional independence.”; “address the psychosocial needs of clients with mental health impairments through client-centered, activity-based interventions designed to develop coping skills, improve day-to-day independent living skills, build functional capacity, and help mitigate and reduce symptoms of mental illness through engagement in healthy roles and routines.”
16. American Occupational Therapy Association. Occupational therapy addressing mental & behavioral health in non-psychiatric settings (August 24, 2022). Checked October 23, 2026.
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    Outpatient clinic: “Enhance skills that identify environmental triggers and build resilience.”; “Provide integrated care to address a person’s functioning in a variety of occupations”; “Promote emotional well-being and mental health management by collaborating with educators, parents, and caregivers to support positive mental health moments” (schools, early intervention and community education).
17. American Occupational Therapy Association. Occupational therapy scope of practice (AOTA practice essentials). “An occupational therapist’s or occupational therapy assistant’s scope of practice is defined in state law. Scope of practice describes the domain of practice and delineates the services that the OT practitioner is deemed qualified to perform and permitted under the law.” Checked October 23, 2026.
18. American Speech-Language-Hearing Association. Social Communication Disorder (ASHA Practice Portal). Checked October 23, 2026.
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    “SCD can result in a wide array of problems, including difficulty participating in social settings, developing peer and/or romantic relationships, achieving academic success, and performing successfully on the job.”; “In the case of autism spectrum disorder, social communication problems are a defining feature, along with restricted, repetitive patterns of behavior. Therefore, SCD cannot be diagnosed in conjunction with autism spectrum disorder.”
19. American Speech-Language-Hearing Association. Selective Mutism (ASHA Practice Portal). Checked October 23, 2026.
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    “Speech-language pathologists are integral members of an interprofessional team and often collaborate with school-based teams (e.g., teachers, guidance counselor, school staff) and behavioral health professionals (e.g., school or clinical psychologist, psychiatrist, school social worker).”; “selective mutism is an anxiety-based disorder that can significantly impact the ability to access speech and language skills.”; “members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.”
20. Office of the Federal Register, Electronic Code of Federal Regulations. 45 CFR 164.510, Uses and disclosures requiring an opportunity for the individual to agree or to object. Checked October 23, 2026.
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    §164.510(b): “A covered entity may, in accordance with paragraphs (b)(2), (b)(3), or (b)(5) of this section, disclose to a family member, other relative, or a close personal friend of the individual, or any other person identified by the individual, the protected health information directly relevant to such person’s involvement with the individual’s health care or payment related to the individual’s health care.”; “If the individual is present for, or otherwise available prior to, a use or disclosure permitted by paragraph (b)(1) of this section and has the capacity to make health care decisions, the covered entity may use or disclose the protected health information if it:”; “(i) Obtains the individual’s agreement;”; “(ii) Provides the individual with the opportunity to object to the disclosure, and the individual does not express an objection;”
21. Office of the Federal Register, Electronic Code of Federal Regulations. 45 CFR 164.506, Uses and disclosures to carry out treatment, payment, or health care operations. Checked October 23, 2026.
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    “Except with respect to uses or disclosures that require an authorization under § 164.508(a)(2) through (4) or that are prohibited under § 164.502(a)(5)(i), a covered entity may use or disclose protected health information for treatment, payment, or health care operations as set forth in paragraph (c) of this section”; “(2) A covered entity may disclose protected health information for treatment activities of a health care provider.”
22. Office of the Federal Register, Electronic Code of Federal Regulations. 45 CFR 160.203, General rule and exceptions (preemption of state law). Checked October 23, 2026.
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    “A standard, requirement, or implementation specification adopted under this subchapter that is contrary to a provision of State law preempts the provision of State law. This general rule applies, except if one or more of the following conditions is met:”; “(b) The provision of State law relates to the privacy of individually identifiable health information and is more stringent than a standard, requirement, or implementation specification adopted under subpart E of part 164 of this subchapter.”
23. Office of the Federal Register, Electronic Code of Federal Regulations. 45 CFR 164.501, Definitions (HIPAA Privacy Rule). Checked October 23, 2026.
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    Psychotherapy notes “means notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: Diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.”
24. Office of the Federal Register, Electronic Code of Federal Regulations. 42 CFR 2.11, Definitions (Confidentiality of Substance Use Disorder Patient Records, Part 2). Checked October 23, 2026.
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    A Part 2 program “means a federally assisted program (federally assisted as defined in § 2.12(b) and program as defined in this section).”; “Program means: (1) A person (other than a general medical facility) that holds itself out as providing, and provides, substance use disorder diagnosis, treatment, or referral for treatment; or”.
25. Office of the Federal Register, Electronic Code of Federal Regulations. 42 CFR 2.32, Notice and copy of consent to accompany disclosure (89 FR 12626, February 16, 2024). Checked October 23, 2026.
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    “(a) Each disclosure made with the patient’s written consent must be accompanied by one of the following written statements”; “These rules prohibit you from using or disclosing this record, or testimony that describes the information contained in this record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against the patient, unless authorized by the consent of the patient, except as provided at 42 CFR 2.12(c)(5) or as authorized by a court in accordance with 42 CFR 2.64 or 2.65.”; “(ii) You are a covered entity or business associate and have received the record for treatment, payment, or health care operations, or”; “A general authorization for the release of medical or other information is NOT sufficient to meet the required elements of written consent to further use or redisclose the record (see 42 CFR 2.31).”; “(b) Each disclosure made with the patient’s written consent must be accompanied by a copy of the consent or a clear explanation of the scope of the consent provided.”
26. Office of the Federal Register, Electronic Code of Federal Regulations. 42 CFR 410.59, Outpatient occupational therapy services: Conditions. Checked October 23, 2026.
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    Medicare Part B pays for outpatient occupational therapy services only under conditions including that “They are furnished to a beneficiary while he or she is under the care of a physician who is a doctor of medicine, osteopathy, or podiatric medicine.”; “They are furnished under a written plan of treatment that meets the requirements of § 410.61.”
27. Office of the Federal Register, Electronic Code of Federal Regulations. 42 CFR 410.60, Outpatient physical therapy services: Conditions. Checked October 23, 2026.
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    Medicare Part B pays for outpatient physical therapy services only under conditions including that “They are furnished to a beneficiary while he or she is under the care of a physician who is a doctor of medicine, osteopathy, or podiatric medicine.”; “They are furnished under a written plan of treatment that meets the requirements of § 410.61.”
28. Office of the Federal Register, Electronic Code of Federal Regulations. 42 CFR 410.62, Outpatient speech-language pathology services: Conditions and exclusions. Checked October 23, 2026.
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    Medicare Part B pays for outpatient speech-language pathology services only under conditions including that “They are furnished to a beneficiary while he or she is under the care of a physician who is a doctor of medicine or osteopathy.”; “They are furnished under a written plan of treatment that meets the requirements of § 410.61.”
29. American Physical Therapy Association. Direct Access Advocacy. Checked October 23, 2026.
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    “As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment. Even though patients may go directly to a physical therapist without a referral, some provisions tied to treatment absent a referral still persist in a number of states”.
30. Federal Trade Commission. Advertising FAQ’s: A Guide for Small Business. Under the Federal Trade Commission Act: “Advertising must be truthful and non-deceptive;”; “Advertisers must have evidence to back up their claims; and”; “Statements from satisfied customers usually are not sufficient to support a health or safety claim or any other claim that requires objective evaluation.” Checked October 23, 2026.
31. Substance Abuse and Mental Health Services Administration. 988 Suicide & Crisis Lifeline. “988 offers 24/7 judgment-free support for mental health, substance use, and more. Text, call, or chat 988.” Checked October 23, 2026.
32. Office of the Federal Register, Electronic Code of Federal Regulations. 45 CFR 164.512, Uses and disclosures for which an authorization or opportunity to agree or object is not required. Checked October 23, 2026.
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    §164.512(j)(1): “A covered entity may, consistent with applicable law and standards of ethical conduct, use or disclose protected health information, if the covered entity, in good faith, believes the use or disclosure:”; “(A) Is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public; and”; “(B) Is to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat;”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It is general guidance on running a therapy practice, not legal, compliance, billing or financial advice. The HIPAA, Part 2 and Medicare points are general information; state law on minors and on mental-health records differs, so your own compliance adviser is the person to ask about your practice.