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TRICARE Reimbursement Manual 6010.55-M, August 2002
Manual Change History
TRICARE Reimbursement Manual 6010.55-M, August 2002
TOC
Change 69 (November 6, 2007)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Foreword
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Introduction
Change 5 (December 24, 2003)
Change 4 (November 27, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Chap 1 -- General
Change 149 (April 26, 2012)
Change 130 (April 1, 2011)
Change 113 (April 9, 2010)
Change 103 (October 28, 2009)
Change 98 (August 19, 2009)
Change 92 (May 8, 2009)
Change 90 (February 4, 2009)
Change 88 (December 22, 2008)
Change 80 (September 16, 2008)
Change 73 (April 7, 2008)
Change 60 (May 22, 2007)
Change 59 (May 7, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Change 24 (February 15, 2005)
Change 21 (December 23, 2004)
Change 19 (December 8, 2004)
Change 12 (September 9, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 1 -- Network Provider Reimbursement
Change 8 (May 5, 2004)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Accommodation Of Discounts Under Provider Reimbursement Methods
Baseline (August 1, 2002)
Sect 3 -- Claims Auditing Software
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Sect 4 -- Reimbursement In Teaching Setting
Baseline (August 1, 2002)
Sect 5 -- National Health Service Corps Physicians Of The Public Health Service
Baseline (August 1, 2002)
Sect 6 -- Reimbursement Of Physician Assistants, Nurse Practitioners, And Certified Psychiatric Nurse Specialists
Change 156 (September 24, 2012)
Change 76 (April 16, 2008)
Change 62 (July 10, 2007)
Change 60 (May 22, 2007)
Change 59 (May 7, 2007)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 7 -- Reimbursement Of Covered Services Provided By Individual Health Care Professionals And Other Non-Institutional Health Care Providers
Change 63 (July 17, 2007)
Baseline (August 1, 2002)
Sect 8 -- Economic Interest In Connection With Mental Health Admissions
Change 23 (February 14, 2005)
Change 18 (December 7, 2004)
Baseline (August 1, 2002)
Sect 9 -- Anesthesia
Change 77 (May 1, 2008)
Change 27 (April 28, 2005)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 10 -- Postoperative Pain Management
Change 77 (May 1, 2008)
Change 27 (April 28, 2005)
Change 11 (August 25, 2004)
Baseline (August 1, 2002)
Sect 11 -- Durable Medical Equipment Claims: Prosthetics, Orthotics, And Supplies (DMEPOS)
Change 132 (April 7, 2011)
Change 120 (September 13, 2010)
Change 118 (August 9, 2010)
Change 75 (April 10, 2008)
Change 62 (July 10, 2007)
Change 24 (February 15, 2005)
Change 19 (December 8, 2004)
Baseline (August 1, 2002)
Sect 12 -- Oxygen And Related Supplies
Change 23 (February 14, 2005)
Change 18 (December 7, 2004)
Baseline (August 1, 2002)
Sect 13 -- Laboratory Services
Change 98 (August 19, 2009)
Change 89 (January 13, 2009)
Baseline (August 1, 2002)
Sect 14 -- Ambulance Services
Change 98 (August 19, 2009)
Change 77 (May 1, 2008)
Change 27 (April 28, 2005)
Change 25 (March 3, 2005)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 15 -- Legend Drugs And Insulin
Change 154 (July 26, 2012)
Change 140 (September 26, 2011)
Change 69 (November 6, 2007)
Change 39 (April 7, 2006)
Change 5 (December 24, 2003)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 16 -- Surgery
Change 110 (March 11, 2010)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 69 (November 6, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Sect 17 -- Assistant Surgeons
Change 77 (May 1, 2008)
Change 42 (June 21, 2006)
Change 27 (April 28, 2005)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 18 -- Professional Services: Obstetrical Care
Change 77 (May 1, 2008)
Change 38 (April 4, 2006)
Change 27 (April 28, 2005)
Change 11 (August 25, 2004)
Baseline (August 1, 2002)
Sect 19 -- Charges For Provider Administrative Expenses
Baseline (August 1, 2002)
Sect 20 -- State Agency Billing
Change 146 (March 15, 2012)
Change 125 (January 28, 2011)
Change 77 (May 1, 2008)
Change 11 (August 25, 2004)
Baseline (August 1, 2002)
Sect 21 -- Hospital Reimbursement - Billed Charges Set Rates
Change 98 (August 19, 2009)
Baseline (August 1, 2002)
Sect 22 -- Hospital Reimbursement - Other Than Billed Charges
Change 98 (August 19, 2009)
Change 12 (September 9, 2004)
Baseline (August 1, 2002)
Sect 23 -- Hospital Reimbursement - Payment When Only SNF Level Of Care Is Required
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Sect 24 -- Hospital Reimbursement - Outpatient Services
Change 148 (April 24, 2012)
Change 110 (March 11, 2010)
Change 98 (August 19, 2009)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 69 (November 6, 2007)
Change 62 (July 10, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 25 -- Preferred Provider Organization (PPO) Reimbursement
Baseline (August 1, 2002)
Sect 26 -- Supplemental Insurance
Baseline (August 1, 2002)
Sect 27 -- Legal Obligation To Pay
Change 98 (August 19, 2009)
Baseline (August 1, 2002)
Sect 28 -- Reduction Of Payment For Noncompliance With Utilization Review Requirements
Change 136 (September 7, 2011)
Change 134 (June 24, 2011)
Change 46 (September 15, 2006)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 29 -- Reimbursement Of Emergency Inpatient Admissions To Unauthorized Facilities
Change 63 (July 17, 2007)
Baseline (August 1, 2002)
Sect 30 -- Reimbursement Of Travel Expenses For Specialty Care
Change 149 (April 26, 2012)
Change 113 (April 9, 2010)
Change 94 (June 11, 2009)
Change 25 (March 3, 2005)
Baseline (August 1, 2002)
Sect 31 -- Newborn Charges
Baseline (August 1, 2002)
Sect 32 -- Hospital-Based Birthing Room
Baseline (August 1, 2002)
Sect 33 -- Bonus Payments In Health Professional Shortage Areas (HPSA) And In Physician Scarcity Areas (PSA)
Change 75 (April 10, 2008)
Change 34 (November 30, 2005)
Change 25 (March 3, 2005)
Change 21 (December 23, 2004)
Change 5 (December 24, 2003)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 34 -- Hospital Inpatient Reimbursement In Locations Outside The 50 United States And The District Of Columbia
Change 90 (February 4, 2009)
Change 80 (September 16, 2008)
Change 73 (April 7, 2008)
Change 16 (October 25, 2004)
Change 12 (September 9, 2004)
Baseline (August 1, 2002)
Sect 35 -- Professional Provider Reimbursement In Specified Locations Outside The 50 United States And The District Of Columbia
Change 80 (September 16, 2008)
Change 73 (April 7, 2008)
Baseline (August 1, 2002)
Sect 36 -- Forensic Examinations Following Sexual Assault or Domestic Violence
Change 103 (October 28, 2009)
Baseline (August 1, 2002)
Sect 37 -- Medical Errors
Change 130 (April 1, 2011)
Baseline (August 1, 2002)
Addendum A -- Sample State Agency Billing Agreement
Change 63 (July 17, 2007)
Baseline (August 1, 2002)
Addendum B -- Figures
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Chap 2 -- Beneficiary Liability
Baseline (August 1, 2002)
Sect 1 -- Cost-Shares And Deductibles
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 128 (March 1, 2011)
Change 121 (October 19, 2010)
Change 102 (October 15, 2009)
Change 101 (October 8, 2009)
Change 95 (June 18, 2009)
Change 92 (May 8, 2009)
Change 86 (November 19, 2008)
Change 85 (October 17, 2008)
Change 83 (September 29, 2008)
Change 77 (May 1, 2008)
Change 75 (April 10, 2008)
Change 74 (April 8, 2008)
Change 69 (November 6, 2007)
Change 68 (October 24, 2007)
Change 66 (September 27, 2007)
Change 50 (October 18, 2006)
Change 48 (September 28, 2006)
Change 47 (September 26, 2006)
Change 32 (October 11, 2005)
Change 29 (September 22, 2005)
Change 27 (April 28, 2005)
Change 25 (March 3, 2005)
Change 23 (February 14, 2005)
Change 18 (December 7, 2004)
Change 17 (November 15, 2004)
Change 14 (October 6, 2004)
Change 11 (August 25, 2004)
Change 7 (April 14, 2004)
Change 6 (March 17, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 2 -- Catastrophic Loss Protection
Change 23 (February 14, 2005)
Change 18 (December 7, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 3 -- Point Of Service Option
Change 26 (April 4, 2005)
Change 10 (May 20, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Addendum A -- Benefits And Beneficiary Payments Under The TRICARE Program
Change 155 (September 21, 2012)
Change 151 (May 7, 2012)
Change 141 (September 28, 2011)
Change 95 (June 18, 2009)
Change 88 (December 22, 2008)
Change 71 (February 14, 2008)
Change 70 (February 11, 2008)
Change 69 (November 6, 2007)
Change 62 (July 10, 2007)
Change 46 (September 15, 2006)
Change 26 (April 4, 2005)
Change 25 (March 3, 2005)
Change 24 (February 15, 2005)
Change 19 (December 8, 2004)
Change 11 (August 25, 2004)
Change 8 (May 5, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Addendum B -- Pharmacy Benefits Program - Cost-Shares
Change 138 (September 21, 2011)
Change 70 (February 11, 2008)
Change 62 (July 10, 2007)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Chap 3 -- Operational Requirements
Change 154 (July 26, 2012)
Change 105 (November 9, 2009)
Baseline (August 1, 2002)
Sect 1 -- Reimbursement Of Individual Health Care Professionals And Other Non-Institutional Health Care Providers
Change 139 (September 23, 2011)
Change 88 (December 22, 2008)
Change 77 (May 1, 2008)
Change 75 (April 10, 2008)
Change 69 (November 6, 2007)
Change 63 (July 17, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 44 (August 23, 2006)
Change 37 (March 17, 2006)
Change 27 (April 28, 2005)
Change 24 (February 15, 2005)
Change 23 (February 14, 2005)
Change 21 (December 23, 2004)
Change 20 (December 17, 2004)
Change 19 (December 8, 2004)
Change 18 (December 7, 2004)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Sect 2 -- Hospital And Other Institutional Reimbursement
Change 98 (August 19, 2009)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 75 (April 10, 2008)
Change 70 (February 11, 2008)
Change 69 (November 6, 2007)
Change 63 (July 17, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 55 (December 21, 2006)
Change 5 (December 24, 2003)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Sect 3 -- Discounts
Change 98 (August 19, 2009)
Baseline (August 1, 2002)
Sect 4 -- Payment Reduction
Change 45 (August 31, 2006)
Baseline (August 1, 2002)
Sect 5 -- Reimbursement Administration
Baseline (August 1, 2002)
Sect 6 -- Processing And Payment Of Home Infusion Claims Before January 30, 2012
Change 154 (July 26, 2012)
Change 105 (November 9, 2009)
Baseline (August 1, 2002)
Sect 7 -- Processing And Payment Of Home Infusion Claims On Or After January 30, 2012
Change 154 (July 26, 2012)
Baseline (August 1, 2002)
Chap 4 -- Double Coverage
Baseline (August 1, 2002)
Sect 1 -- Double Coverage
Change 98 (August 19, 2009)
Change 94 (June 11, 2009)
Baseline (August 1, 2002)
Sect 2 -- Double Coverage Review And Processing Of Claims
Change 25 (March 3, 2005)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 3 -- Coordination Of Benefits
Change 146 (March 15, 2012)
Change 98 (August 19, 2009)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 69 (November 6, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Sect 4 -- Specific Double Coverage Actions
Change 156 (September 24, 2012)
Change 146 (March 15, 2012)
Change 137 (September 12, 2011)
Change 129 (March 10, 2011)
Change 69 (November 6, 2007)
Change 62 (July 10, 2007)
Change 58 (February 1, 2007)
Change 56 (December 28, 2006)
Change 45 (August 31, 2006)
Change 40 (April 26, 2006)
Change 23 (February 14, 2005)
Change 18 (December 7, 2004)
Change 8 (May 5, 2004)
Change 5 (December 24, 2003)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Chap 5 -- Allowable Charges
Change 11 (August 25, 2004)
Baseline (August 1, 2002)
Sect 1 -- Allowable Charges - Non-Network Providers
Change 139 (September 23, 2011)
Baseline (August 1, 2002)
Sect 2 -- Locality-Based Reimbursement Rate Waiver
Change 76 (April 16, 2008)
Change 75 (April 10, 2008)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 3 -- Allowable Charges - CHAMPUS Maximum Allowable Charges (CMAC)
Change 143 (December 6, 2011)
Change 139 (September 23, 2011)
Change 110 (March 11, 2010)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 75 (April 10, 2008)
Change 69 (November 6, 2007)
Change 63 (July 17, 2007)
Change 60 (May 22, 2007)
Change 59 (May 7, 2007)
Change 57 (January 16, 2007)
Change 45 (August 31, 2006)
Change 37 (March 17, 2006)
Change 24 (February 15, 2005)
Change 21 (December 23, 2004)
Change 20 (December 17, 2004)
Change 19 (December 8, 2004)
Change 18 (December 7, 2004)
Change 11 (August 25, 2004)
Baseline (August 1, 2002)
Sect 4 -- Individual Consideration Cases
Change 11 (August 25, 2004)
Baseline (August 1, 2002)
Sect 5 -- Payment For Professional/Technical Components Of Diagnostic Services
Change 98 (August 19, 2009)
Change 11 (August 25, 2004)
Baseline (August 1, 2002)
Chap 6 -- Diagnostic Related Groups (DRGs)
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 128 (March 1, 2011)
Change 104 (November 3, 2009)
Change 102 (October 15, 2009)
Change 85 (October 17, 2008)
Change 66 (September 27, 2007)
Change 50 (October 18, 2006)
Change 29 (September 22, 2005)
Change 22 (January 26, 2005)
Change 15 (October 22, 2004)
Change 13 (October 1, 2004)
Change 5 (December 24, 2003)
Change 4 (November 27, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 1 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (General)
Change 79 (June 30, 2008)
Baseline (August 1, 2002)
Sect 2 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (General Description Of System)
Change 79 (June 30, 2008)
Change 63 (July 17, 2007)
Change 15 (October 22, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 3 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Basis Of Payment)
Change 128 (March 1, 2011)
Change 117 (July 9, 2010)
Change 102 (October 15, 2009)
Change 85 (October 17, 2008)
Change 79 (June 30, 2008)
Change 66 (September 27, 2007)
Change 63 (July 17, 2007)
Change 50 (October 18, 2006)
Change 29 (September 22, 2005)
Change 15 (October 22, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 4 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Applicability Of The DRG System)
Change 128 (March 1, 2011)
Change 111 (March 17, 2010)
Change 98 (August 19, 2009)
Change 79 (June 30, 2008)
Change 69 (November 6, 2007)
Change 54 (November 9, 2006)
Change 50 (October 18, 2006)
Change 40 (April 26, 2006)
Change 29 (September 22, 2005)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 5 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Determination Of Payment Amounts)
Change 6 (March 17, 2004)
Baseline (August 1, 2002)
Sect 6 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (DRG Weighting Factors)
Change 79 (June 30, 2008)
Change 29 (September 22, 2005)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Sect 7 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Adjusted Standardized Amounts)
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 128 (March 1, 2011)
Change 102 (October 15, 2009)
Change 85 (October 17, 2008)
Change 66 (September 27, 2007)
Change 50 (October 18, 2006)
Change 29 (September 22, 2005)
Change 15 (October 22, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 8 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Adjustments To Payment Amounts)
Change 159 (April 3, 2013)
Change 158 (November 26, 2012)
Change 157 (October 15, 2012)
Change 147 (April 5, 2012)
Change 142 (November 9, 2011)
Change 135 (July 5, 2011)
Change 128 (March 1, 2011)
Change 119 (August 27, 2010)
Change 115 (May 13, 2010)
Change 102 (October 15, 2009)
Change 99 (September 25, 2009)
Change 96 (June 22, 2009)
Change 94 (June 11, 2009)
Change 86 (November 19, 2008)
Change 85 (October 17, 2008)
Change 81 (September 19, 2008)
Change 79 (June 30, 2008)
Change 66 (September 27, 2007)
Change 52 (October 27, 2006)
Change 50 (October 18, 2006)
Change 29 (September 22, 2005)
Change 15 (October 22, 2004)
Change 9 (May 6, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 9 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Information Provided By TMA)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Sect 10 -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Charges To Beneficiaries)
Baseline (August 1, 2002)
Addendum A -- Health Benefit Program Agreement
Baseline (August 1, 2002)
Addendum B -- Fiscal Year 2011 TRICARE/CHAMPUS Adjusted Standardized Amounts
Change 128 (March 1, 2011)
Baseline (August 1, 2002)
Addendum B -- Fiscal Year 2012 TRICARE/CHAMPUS Adjusted Standardized Amounts
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum B -- Fiscal Year 2013 TRICARE/CHAMPUS Adjusted Standardized Amounts
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Addendum C -- Diagnosis Related Groups (DRGs), DRG Relative Weights, Arithmetic And Geometric Mean Lengths-Of-Stay, And Short-Stay Outlier Thresholds (Effective For Admissions On Or After 10/01/2010)
Change 142 (November 9, 2011)
Change 128 (March 1, 2011)
Baseline (August 1, 2002)
Addendum C -- Diagnosis Related Groups (DRGs), DRG Relative Weights, Arithmetic And Geometric Mean Lengths-Of-Stay, And Short-Stay Outlier Thresholds (Effective For Admissions On Or After 10/01/2011)
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum C -- Diagnosis Related Groups (DRGs), DRG Relative Weights, Arithmetic And Geometric Mean Lengths-Of-Stay, And Short-Stay Outlier Thresholds (Effective For Admissions On Or After 10/01/2012)
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Chap 7 -- Mental Health
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 121 (October 19, 2010)
Change 109 (January 12, 2010)
Change 101 (October 8, 2009)
Change 99 (September 25, 2009)
Change 98 (August 19, 2009)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 86 (November 19, 2008)
Change 84 (October 14, 2008)
Change 68 (October 24, 2007)
Change 60 (May 22, 2007)
Change 47 (September 26, 2006)
Change 43 (July 27, 2006)
Change 38 (April 4, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 29 (September 22, 2005)
Change 28 (July 27, 2005)
Change 14 (October 6, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 1 -- Hospital Reimbursement - TRICARE/CHAMPUS Inpatient Mental Health Per Diem Payment System
Change 159 (April 3, 2013)
Change 158 (November 26, 2012)
Change 145 (January 18, 2012)
Change 142 (November 9, 2011)
Change 135 (July 5, 2011)
Change 121 (October 19, 2010)
Change 104 (November 3, 2009)
Change 101 (October 8, 2009)
Change 99 (September 25, 2009)
Change 86 (November 19, 2008)
Change 79 (June 30, 2008)
Change 69 (November 6, 2007)
Change 68 (October 24, 2007)
Change 47 (September 26, 2006)
Change 36 (December 20, 2005)
Change 29 (September 22, 2005)
Change 14 (October 6, 2004)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 2 -- Psychiatric Partial Hospitalization Program (PHP) Reimbursement
Change 152 (May 17, 2012)
Change 98 (August 19, 2009)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 60 (May 22, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 29 (September 22, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Sect 3 -- Substance Use Disorder Rehabilitation Facilities (SUDRFs) Reimbursement
Change 152 (May 17, 2012)
Change 99 (September 25, 2009)
Change 77 (May 1, 2008)
Change 27 (April 28, 2005)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 4 -- Residential Treatment Center (RTC) Reimbursement
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum A -- Table Of Regional Specific Rates For Psychiatric Hospitals And Units With Low TRICARE Volume (FY 2011 - FY 2013)
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 121 (October 19, 2010)
Change 111 (March 17, 2010)
Change 101 (October 8, 2009)
Change 86 (November 19, 2008)
Change 68 (October 24, 2007)
Change 62 (July 10, 2007)
Change 51 (October 24, 2006)
Change 50 (October 18, 2006)
Change 47 (September 26, 2006)
Change 36 (December 20, 2005)
Change 30 (September 29, 2005)
Change 29 (September 22, 2005)
Change 28 (July 27, 2005)
Change 14 (October 6, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Addendum B -- Table Of Maximum Rates For Freestanding Psychiatric Partial Hospitalization Programs (PHPs) Reimbursement (FY 2011 - FY 2013)
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 121 (October 19, 2010)
Change 111 (March 17, 2010)
Change 101 (October 8, 2009)
Change 92 (May 8, 2009)
Change 86 (November 19, 2008)
Change 68 (October 24, 2007)
Change 60 (May 22, 2007)
Change 47 (September 26, 2006)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum C -- TRICARE/CHAMPUS Standards For Inpatient Rehabilitation And Partial Hospitalization For The Treatment Of Substance Use Disorders (SUDRFs)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum C -- Participation Agreement For Substance Use Disorder Rehabilitation Facility (SUDRF) Services For TRICARE/CHAMPUS Beneficiaries
Change 63 (July 17, 2007)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum D -- Participation Agreement For Residential Treatment Center (RTC)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum D -- TRICARE/CHAMPUS Standards For Inpatient Rehabilitation And Partial Hospitalization For The Treatment Of Substance Use Disorders (SUDRFs)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum E -- Guidelines For The Calculation Of Individual Residential Treatment Center (RTC) Per Diem Rates
Change 29 (September 22, 2005)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Addendum E -- Participation Agreement For Residential Treatment Center (RTC)
Change 63 (July 17, 2007)
Change 29 (September 22, 2005)
Change 14 (October 6, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Addendum F -- Guidelines For The Calculation Of Individual Residential Treatment Center (RTC) Per Diem Rates
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum F -- Guidelines For The Calculation Of Individual Residential Treatment Center (RTC) Per Diem Rates
Change 142 (November 9, 2011)
Change 40 (April 26, 2006)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum G -- TRICARE-Authorized Residential Treatment Centers - For Payment Of Services Provided On Or After 10/01/2010
Change 157 (October 15, 2012)
Change 147 (April 5, 2012)
Change 142 (November 9, 2011)
Change 121 (October 19, 2010)
Baseline (August 1, 2002)
Addendum G -- TRICARE-Authorized Residential Treatment Centers - For Payment Of Services Provided On Or After 10/01/2011
Change 159 (April 3, 2013)
Change 158 (November 26, 2012)
Change 157 (October 15, 2012)
Change 147 (April 5, 2012)
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum G -- TRICARE-Authorized Residential Treatment Centers - For Payment Of Services Provided On Or After 10/01/2012
Change 159 (April 3, 2013)
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Addendum H -- TRICARE/CHAMPUS Standards For Residential Treatment Centers (RTCs) Serving Children And Adolescents
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum H -- TRICARE/CHAMPUS Standards For Residential Treatment Centers (RTCs) Serving Children And Adolescents
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum I -- Participation Agreement For Freestanding Psychiatric Partial Hospitalization Program Services
Change 109 (January 12, 2010)
Change 43 (July 27, 2006)
Baseline (August 1, 2002)
Addendum I -- Participation Agreement For Freestanding Psychiatric Partial Hospitalization Program Services
Change 109 (January 12, 2010)
Change 63 (July 17, 2007)
Change 43 (July 27, 2006)
Baseline (August 1, 2002)
Chap 8 -- Skilled Nursing Facilities (SNFs)
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 123 (December 2, 2010)
Change 100 (September 29, 2009)
Change 87 (December 12, 2008)
Change 64 (September 14, 2007)
Change 62 (July 10, 2007)
Change 49 (October 5, 2006)
Change 35 (December 15, 2005)
Change 29 (September 22, 2005)
Change 14 (October 6, 2004)
Change 8 (May 5, 2004)
Change 4 (November 27, 2002)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Sect 1 -- Skilled Nursing Facility (SNF) Reimbursement
Change 98 (August 19, 2009)
Change 5 (December 24, 2003)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 2 -- Skilled Nursing Facility (SNF) Prospective Payment System (PPS)
Change 154 (July 26, 2012)
Change 134 (June 24, 2011)
Change 123 (December 2, 2010)
Change 100 (September 29, 2009)
Change 98 (August 19, 2009)
Change 76 (April 16, 2008)
Change 63 (July 17, 2007)
Change 62 (July 10, 2007)
Change 49 (October 5, 2006)
Change 35 (December 15, 2005)
Change 8 (May 5, 2004)
Change 5 (December 24, 2003)
Change 4 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Addendum A -- RUG-III/IV
Change 134 (June 24, 2011)
Change 123 (December 2, 2010)
Change 62 (July 10, 2007)
Baseline (August 1, 2002)
Addendum B -- Example Of Computation Of Adjusted PPS Rates And SNF Payment For Fiscal Year 2011
Change 123 (December 2, 2010)
Baseline (August 1, 2002)
Addendum B -- Example Of Computation Of Adjusted PPS Rates And SNF Payment For Fiscal Year 2012
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum B -- Example Of Computation Of Adjusted PPS Rates And SNF Payment For Fiscal Year 2013
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Addendum C -- Fact Sheet Regarding Consolidated Billing and Ambulance Services
Change 62 (July 10, 2007)
Change 49 (October 5, 2006)
Change 35 (December 15, 2005)
Baseline (August 1, 2002)
Addendum D -- Case-Mix Adjusted Federal Rates For SNFs - Fiscal Year 2011
Change 123 (December 2, 2010)
Baseline (August 1, 2002)
Addendum D -- Case-Mix Adjusted Federal Rates For SNFs - Fiscal Year 2012
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum D -- Case-Mix Adjusted Federal Rates For SNFs - Fiscal Year 2013
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Addendum E -- Wage Indexes For Urban Areas For SNFs Based On CBSA Labor Market Areas - Fiscal Year 2011
Change 134 (June 24, 2011)
Change 123 (December 2, 2010)
Baseline (August 1, 2002)
Addendum E -- Wage Indexes For Urban Areas For SNFs Based On CBSA Labor Market Areas - Fiscal Year 2012
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum E -- Wage Indexes For Urban Areas For SNFs Based On CBSA Labor Market Areas - Fiscal Year 2013
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Addendum F -- Wage Indexes For Rural Areas For SNFs Based On CBSA Labor Market Areas - Fiscal Year 2011
Change 123 (December 2, 2010)
Baseline (August 1, 2002)
Addendum F -- Wage Indexes For Rural Areas For SNFs Based On CBSA Labor Market Areas - Fiscal Year 2012
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum F -- Wage Indexes For Rural Areas For SNFs Based On CBSA Labor Market Areas - Fiscal Year 2013
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Addendum G -- Letter To Skilled Nursing Facility (SNF) RE: New Participation Agreement
Change 62 (July 10, 2007)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Chap 9 -- Ambulatory Surgery Centers (ASCs)
Change 98 (August 19, 2009)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 69 (November 6, 2007)
Change 60 (May 22, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 1 -- Ambulatory Surgical Center (ASC) Reimbursement
Change 159 (April 3, 2013)
Change 142 (November 9, 2011)
Change 110 (March 11, 2010)
Change 107 (December 7, 2009)
Change 98 (August 19, 2009)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 77 (May 1, 2008)
Change 69 (November 6, 2007)
Change 63 (July 17, 2007)
Change 61 (May 24, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 40 (April 26, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Change 27 (April 28, 2005)
Change 11 (August 25, 2004)
Change 6 (March 17, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Chap 10 -- Birthing Centers
Change 153 (May 23, 2012)
Change 131 (April 5, 2011)
Change 114 (May 6, 2010)
Change 87 (December 12, 2008)
Change 65 (September 26, 2007)
Change 57 (January 16, 2007)
Change 49 (October 5, 2006)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 29 (September 22, 2005)
Change 28 (July 27, 2005)
Change 14 (October 6, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Sect 1 -- Freestanding And Hospital-Based Birthing Center Reimbursement
Change 92 (May 8, 2009)
Change 87 (December 12, 2008)
Change 77 (May 1, 2008)
Change 69 (November 6, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Change 27 (April 28, 2005)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Addendum A -- Birthing Center Rate Non-Professional Component
Change 153 (May 23, 2012)
Change 131 (April 5, 2011)
Change 114 (May 6, 2010)
Change 87 (December 12, 2008)
Change 70 (February 11, 2008)
Change 69 (November 6, 2007)
Change 65 (September 26, 2007)
Change 49 (October 5, 2006)
Change 29 (September 22, 2005)
Change 14 (October 6, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Chap 11 -- Hospice
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 122 (October 28, 2010)
Change 108 (December 30, 2009)
Change 104 (November 3, 2009)
Change 84 (October 14, 2008)
Change 68 (October 24, 2007)
Change 47 (September 26, 2006)
Change 29 (September 22, 2005)
Change 14 (October 6, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 1 -- Hospice Reimbursement - General Overview
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 122 (October 28, 2010)
Change 108 (December 30, 2009)
Change 104 (November 3, 2009)
Change 84 (October 14, 2008)
Change 68 (October 24, 2007)
Change 63 (July 17, 2007)
Change 47 (September 26, 2006)
Change 29 (September 22, 2005)
Change 15 (October 22, 2004)
Change 14 (October 6, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 2 -- Hospice Reimbursement - Coverage/Benefits
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Sect 3 -- Hospice Reimbursement - Conditions For Coverage
Change 63 (July 17, 2007)
Change 40 (April 26, 2006)
Change 29 (September 22, 2005)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Sect 4 -- Hospice Reimbursement - Guidelines For Payment Of Designated Levels Of Care
Change 158 (November 26, 2012)
Change 142 (November 9, 2011)
Change 122 (October 28, 2010)
Change 108 (December 30, 2009)
Change 104 (November 3, 2009)
Change 94 (June 11, 2009)
Change 68 (October 24, 2007)
Change 63 (July 17, 2007)
Change 47 (September 26, 2006)
Change 29 (September 22, 2005)
Change 15 (October 22, 2004)
Change 14 (October 6, 2004)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Addendum A -- Fiscal Year 2011 Rates For Hospice Care
Change 122 (October 28, 2010)
Baseline (August 1, 2002)
Addendum A -- Fiscal Year 2012 Rates For Hospice Care
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum A -- Fiscal Year 2013 Rates For Hospice Care
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Addendum B -- Hospice Rate Information - FY 2011 Hospice Wage Indexes For Urban Areas
Change 141 (September 28, 2011)
Change 122 (October 28, 2010)
Baseline (August 1, 2002)
Addendum B -- Hospice Rate Information - FY 2012 Hospice Wage Indexes For Urban Areas
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum B -- Hospice Rate Information - FY 2013 Hospice Wage Indexes For Urban Areas
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Addendum C -- Hospice Rate Information - FY 2011 Hospice Wage Indexes For Rural Areas
Change 122 (October 28, 2010)
Baseline (August 1, 2002)
Addendum C -- Hospice Rate Information - FY 2012 Hospice Wage Indexes For Rural Areas
Change 142 (November 9, 2011)
Baseline (August 1, 2002)
Addendum C -- Hospice Rate Information - FY 2013 Hospice Wage Indexes For Rural Areas
Change 158 (November 26, 2012)
Baseline (August 1, 2002)
Addendum D -- Crosswalk Of Counties By States For Fiscal Year 2006
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum E -- Participation Agreement For Hospice Program Services For TRICARE/CHAMPUS Beneficiaries
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Addendum E -- Participation Agreement For Hospice Program Services For TRICARE/CHAMPUS Beneficiaries
Change 63 (July 17, 2007)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Chap 12 -- Home Health Care
Change 159 (April 3, 2013)
Change 147 (April 5, 2012)
Change 133 (June 2, 2011)
Change 126 (February 2, 2011)
Change 112 (March 25, 2010)
Change 93 (May 29, 2009)
Change 82 (September 24, 2008)
Change 72 (February 28, 2008)
Change 63 (July 17, 2007)
Change 41 (May 22, 2006)
Change 15 (October 22, 2004)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 1 -- Home Health Benefit Coverage And Reimbursement - General Overview
Change 159 (April 3, 2013)
Change 147 (April 5, 2012)
Change 133 (June 2, 2011)
Change 112 (March 25, 2010)
Change 93 (May 29, 2009)
Change 72 (February 28, 2008)
Change 63 (July 17, 2007)
Change 41 (May 22, 2006)
Change 11 (August 25, 2004)
Change 5 (December 24, 2003)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 2 -- Home Health Care - Benefits And Conditions For Coverage
Change 156 (September 24, 2012)
Change 140 (September 26, 2011)
Change 133 (June 2, 2011)
Change 63 (July 17, 2007)
Change 41 (May 22, 2006)
Change 39 (April 7, 2006)
Change 22 (January 26, 2005)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 3 -- Home Health Benefit Coverage And Reimbursement - Assessment Process
Change 133 (June 2, 2011)
Change 72 (February 28, 2008)
Change 63 (July 17, 2007)
Change 5 (December 24, 2003)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 4 -- Home Health Benefit Coverage And Reimbursement - Prospective Payment Methodology
Change 159 (April 3, 2013)
Change 147 (April 5, 2012)
Change 141 (September 28, 2011)
Change 133 (June 2, 2011)
Change 112 (March 25, 2010)
Change 93 (May 29, 2009)
Change 82 (September 24, 2008)
Change 78 (June 17, 2008)
Change 72 (February 28, 2008)
Change 63 (July 17, 2007)
Change 41 (May 22, 2006)
Change 15 (October 22, 2004)
Change 3 (November 7, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 5 -- Home Health Benefit Coverage And Reimbursement - Primary Provider Status And Episodes Of Care
Change 146 (March 15, 2012)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Sect 6 -- Home Health Benefit Coverage And Reimbursement - Claims And Billing Submission Under HHA PPS
Change 159 (April 3, 2013)
Change 147 (April 5, 2012)
Change 133 (June 2, 2011)
Change 127 (February 17, 2011)
Change 72 (February 28, 2008)
Change 63 (July 17, 2007)
Change 5 (December 24, 2003)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 7 -- Home Health Benefit Coverage And Reimbursement - Pricer Requirements And Logic
Change 159 (April 3, 2013)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Sect 8 -- Home Health Benefit Coverage And Reimbursement - Medical Review Requirements
Change 156 (September 24, 2012)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum A -- Definitions And Acronym Table
Change 133 (June 2, 2011)
Change 63 (July 17, 2007)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum B -- Home Health (HH) Consolidated Billing Code List - Non-Routine Supply (NRS) Codes
Change 159 (April 3, 2013)
Change 147 (April 5, 2012)
Change 72 (February 28, 2008)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Addendum C -- Home Health (HH) Consolidated Billing Code List - Therapy Codes
Change 72 (February 28, 2008)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Addendum D -- CMS Form 485 - Home Health Certification And Plan Of Care Data Elements
Change 63 (July 17, 2007)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Addendum E -- Primary Components Of A Home Care Patient Assessment
Baseline (August 1, 2002)
Addendum F -- Outcome And Assessment Information Set (OASIS-B1)
Baseline (August 1, 2002)
Addendum G -- Outcome and Assessment Information Set (OASIS) Items Used For Assessments Of 60-Day Episodes
Change 133 (June 2, 2011)
Baseline (August 1, 2002)
Addendum H -- Diagnosis Codes For Home Health Resource Group (HHRG) Assignment
Change 159 (April 3, 2013)
Baseline (August 1, 2002)
Addendum I -- Home Health Resource Group (HHRG) Worksheet
Change 133 (June 2, 2011)
Change 82 (September 24, 2008)
Baseline (August 1, 2002)
Addendum J -- Health Insurance Prospective Payment System (HIPPS) Tables For Pricer
Change 147 (April 5, 2012)
Change 133 (June 2, 2011)
Baseline (August 1, 2002)
Addendum K -- Home Assessment Validation And Entry (HAVEN) Reference Manual
Change 133 (June 2, 2011)
Baseline (August 1, 2002)
Addendum L -- Annual HHA PPS Rate Updates - Calendar Year 2011
Change 133 (June 2, 2011)
Baseline (August 1, 2002)
Addendum L -- Annual HHA PPS Rate Updates - Calendar Year 2012
Change 159 (April 3, 2013)
Change 147 (April 5, 2012)
Baseline (August 1, 2002)
Addendum L -- Annual HHA PPS Rate Updates - Calendar Year 2013
Change 159 (April 3, 2013)
Baseline (August 1, 2002)
Addendum M -- Annual HHA PPS Wage Index Updates - Calendar Year 2011
Change 133 (June 2, 2011)
Baseline (August 1, 2002)
Addendum M -- Annual HHA PPS Wage Index Updates - Calendar Year 2012
Change 147 (April 5, 2012)
Baseline (August 1, 2002)
Addendum M -- Annual HHA PPS Wage Index Updates - Calendar Year 2013
Change 159 (April 3, 2013)
Baseline (August 1, 2002)
Addendum N -- Diagnoses Associated With Each Of The Diagnostic Categories Used In Case-Mix Scoring
Change 159 (April 3, 2013)
Change 133 (June 2, 2011)
Change 72 (February 28, 2008)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Addendum O -- Diagnoses Included In The Diagnostic Categories Used For The Non-Routine Supplies (NRS) Case-Mix Adjustment Model
Change 159 (April 3, 2013)
Change 133 (June 2, 2011)
Change 72 (February 28, 2008)
Change 63 (July 17, 2007)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Addendum P -- Code Table For Converting Julian Dates To Two Position Alphabetic Values
Change 133 (June 2, 2011)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Addendum Q -- Examples Of Claims Submission Under Home Health Agency Prospective Payment System (HHA PPS)
Change 133 (June 2, 2011)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Addendum R -- Input/Output Record Layout
Change 133 (June 2, 2011)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Addendum S -- Decision Logic Used By The Pricer For Episodes Beginning On Or After January 1, 2008
Change 159 (April 3, 2013)
Change 133 (June 2, 2011)
Change 78 (June 17, 2008)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Chap 13 -- Outpatient Prospective Payment System (OPPS) - Ambulatory Payment Classifications (APCs)
Change 92 (May 8, 2009)
Change 91 (April 16, 2009)
Change 88 (December 22, 2008)
Change 69 (November 6, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Sect 1 -- General
Change 150 (May 4, 2012)
Change 118 (August 9, 2010)
Change 110 (March 11, 2010)
Change 92 (May 8, 2009)
Change 91 (April 16, 2009)
Change 88 (December 22, 2008)
Change 77 (May 1, 2008)
Change 69 (November 6, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 29 (September 22, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Sect 2 -- Billing And Coding Of Services Under APC Groups
Change 146 (March 15, 2012)
Change 110 (March 11, 2010)
Change 109 (January 12, 2010)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 77 (May 1, 2008)
Change 69 (November 6, 2007)
Change 63 (July 17, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Sect 3 -- Prospective Payment Methodology
Change 159 (April 3, 2013)
Change 157 (October 15, 2012)
Change 152 (May 17, 2012)
Change 150 (May 4, 2012)
Change 140 (September 26, 2011)
Change 116 (June 24, 2010)
Change 110 (March 11, 2010)
Change 92 (May 8, 2009)
Change 91 (April 16, 2009)
Change 88 (December 22, 2008)
Change 77 (May 1, 2008)
Change 69 (November 6, 2007)
Change 63 (July 17, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 29 (September 22, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Sect 4 -- Claims Submission And Processing Requirements
Change 110 (March 11, 2010)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 69 (November 6, 2007)
Change 63 (July 17, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Sect 5 -- Medical Review And Allowable Charge Review Under The Outpatient Prospective Payment System (OPPS)
Change 88 (December 22, 2008)
Change 69 (November 6, 2007)
Change 60 (May 22, 2007)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Addendum A1 -- Development Schedule For TRICARE OCE/APC Quarterly Update
Change 88 (December 22, 2008)
Change 69 (November 6, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Baseline (August 1, 2002)
Addendum A2 -- OPPS OCE Notification Process For Quarterly Updates
Change 88 (December 22, 2008)
Change 69 (November 6, 2007)
Change 60 (May 22, 2007)
Change 57 (January 16, 2007)
Baseline (August 1, 2002)
Addendum A3 -- Approval Of OPPS - OCE/APC And NGPL Quarterly Update Process
Change 88 (December 22, 2008)
Baseline (August 1, 2002)
Chap 14 -- Sole Community Hospitals
Change 69 (November 6, 2007)
Baseline (August 1, 2002)
Sect 1 -- Sole Community Hospitals (SCHs)
Change 69 (November 6, 2007)
Baseline (August 1, 2002)
Chap 15 -- Critical Access Hospitals (CAHs)
Change 69 (November 6, 2007)
Baseline (August 1, 2002)
Sect 1 -- Critical Access Hospitals (CAHs)
Change 159 (April 3, 2013)
Change 145 (January 18, 2012)
Change 144 (January 10, 2012)
Change 124 (December 22, 2010)
Change 106 (December 1, 2009)
Change 98 (August 19, 2009)
Change 69 (November 6, 2007)
Baseline (August 1, 2002)
Index
Change 159 (April 3, 2013)
Change 158 (November 26, 2012)
Change 154 (July 26, 2012)
Change 149 (April 26, 2012)
Change 147 (April 5, 2012)
Change 142 (November 9, 2011)
Change 133 (June 2, 2011)
Change 130 (April 1, 2011)
Change 128 (March 1, 2011)
Change 123 (December 2, 2010)
Change 122 (October 28, 2010)
Change 121 (October 19, 2010)
Change 113 (April 9, 2010)
Change 112 (March 25, 2010)
Change 109 (January 12, 2010)
Change 108 (December 30, 2009)
Change 105 (November 9, 2009)
Change 104 (November 3, 2009)
Change 103 (October 28, 2009)
Change 102 (October 15, 2009)
Change 101 (October 8, 2009)
Change 100 (September 29, 2009)
Change 99 (September 25, 2009)
Change 98 (August 19, 2009)
Change 93 (May 29, 2009)
Change 92 (May 8, 2009)
Change 88 (December 22, 2008)
Change 87 (December 12, 2008)
Change 86 (November 19, 2008)
Change 85 (October 17, 2008)
Change 84 (October 14, 2008)
Change 73 (April 7, 2008)
Change 72 (February 28, 2008)
Change 69 (November 6, 2007)
Change 68 (October 24, 2007)
Change 66 (September 27, 2007)
Change 64 (September 14, 2007)
Change 62 (July 10, 2007)
Change 60 (May 22, 2007)
Change 59 (May 7, 2007)
Change 57 (January 16, 2007)
Change 50 (October 18, 2006)
Change 49 (October 5, 2006)
Change 47 (September 26, 2006)
Change 43 (July 27, 2006)
Change 41 (May 22, 2006)
Change 37 (March 17, 2006)
Change 35 (December 15, 2005)
Change 33 (October 20, 2005)
Change 29 (September 22, 2005)
Change 28 (July 27, 2005)
Change 24 (February 15, 2005)
Change 22 (January 26, 2005)
Change 21 (December 23, 2004)
Change 19 (December 8, 2004)
Change 15 (October 22, 2004)
Change 14 (October 6, 2004)
Change 13 (October 1, 2004)
Change 12 (September 9, 2004)
Change 11 (August 25, 2004)
Change 8 (May 5, 2004)
Change 5 (December 24, 2003)
Change 4 (November 27, 2002)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Change 1 (August 26, 2002)
Baseline (August 1, 2002)
Obsolete Files
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Change 4 (November 27, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Change 29 (September 22, 2005)
Change 5 (December 24, 2003)
Change 3 (November 7, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Change 14 (October 6, 2004)
Change 2 (September 25, 2002)
Baseline (August 1, 2002)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Change 77 (May 1, 2008)
Change 5 (December 24, 2003)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Change 3 (November 7, 2002)
Baseline (August 1, 2002)
Change 4 (November 27, 2002)
Baseline (August 1, 2002)
Change 4 (November 27, 2002)
Baseline (August 1, 2002)
Change 4 (November 27, 2002)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Change 35 (December 15, 2005)
Change 22 (January 26, 2005)
Change 8 (May 5, 2004)
Change 5 (December 24, 2003)
Change 4 (November 27, 2002)
Baseline (August 1, 2002)
Change 6 (March 17, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Change 13 (October 1, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 13 (October 1, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 77 (May 1, 2008)
Change 61 (May 24, 2007)
Change 47 (September 26, 2006)
Change 40 (April 26, 2006)
Change 29 (September 22, 2005)
Change 27 (April 28, 2005)
Change 13 (October 1, 2004)
Change 11 (August 25, 2004)
Change 6 (March 17, 2004)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 5 (December 24, 2003)
Baseline (August 1, 2002)
Change 14 (October 6, 2004)
Change 8 (May 5, 2004)
Baseline (August 1, 2002)
Change 8 (May 5, 2004)
Baseline (August 1, 2002)
Change 8 (May 5, 2004)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Change 8 (May 5, 2004)
Baseline (August 1, 2002)
Change 8 (May 5, 2004)
Baseline (August 1, 2002)
Change 8 (May 5, 2004)
Baseline (August 1, 2002)
Change 13 (October 1, 2004)
Baseline (August 1, 2002)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Change 22 (January 26, 2005)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 22 (January 26, 2005)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 14 (October 6, 2004)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 22 (January 26, 2005)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 15 (October 22, 2004)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 33 (October 20, 2005)
Change 28 (July 27, 2005)
Baseline (August 1, 2002)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 40 (April 26, 2006)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Change 35 (December 15, 2005)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Change 35 (December 15, 2005)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 31 (October 5, 2005)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 31 (October 5, 2005)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 29 (September 22, 2005)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Change 37 (March 17, 2006)
Baseline (August 1, 2002)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Change 41 (May 22, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Baseline (August 1, 2002)
Change 63 (July 17, 2007)
Change 43 (July 27, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Baseline (August 1, 2002)
Change 43 (July 27, 2006)
Baseline (August 1, 2002)
Change 47 (September 26, 2006)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Change 47 (September 26, 2006)
Baseline (August 1, 2002)
Change 61 (May 24, 2007)
Change 53 (November 7, 2006)
Change 49 (October 5, 2006)
Change 47 (September 26, 2006)
Baseline (August 1, 2002)
Change 53 (November 7, 2006)
Change 47 (September 26, 2006)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Change 49 (October 5, 2006)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Change 49 (October 5, 2006)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Change 49 (October 5, 2006)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Baseline (August 1, 2002)
Change 49 (October 5, 2006)
Baseline (August 1, 2002)
Change 50 (October 18, 2006)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Baseline (August 1, 2002)
Change 62 (July 10, 2007)
Baseline (August 1, 2002)
Change 64 (September 14, 2007)
Baseline (August 1, 2002)
Change 64 (September 14, 2007)
Baseline (August 1, 2002)
Change 65 (September 26, 2007)
Change 64 (September 14, 2007)
Baseline (August 1, 2002)
Change 87 (December 12, 2008)
Change 64 (September 14, 2007)
Baseline (August 1, 2002)
Change 67 (October 10, 2007)
Change 66 (September 27, 2007)
Baseline (August 1, 2002)
Change 93 (May 29, 2009)
Change 68 (October 24, 2007)
Baseline (August 1, 2002)
Change 68 (October 24, 2007)
Baseline (August 1, 2002)
Change 68 (October 24, 2007)
Baseline (August 1, 2002)
Change 68 (October 24, 2007)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 72 (February 28, 2008)
Baseline (August 1, 2002)
Change 93 (May 29, 2009)
Change 84 (October 14, 2008)
Baseline (August 1, 2002)
Change 86 (November 19, 2008)
Change 84 (October 14, 2008)
Baseline (August 1, 2002)
Change 97 (July 16, 2009)
Change 84 (October 14, 2008)
Baseline (August 1, 2002)
Change 97 (July 16, 2009)
Change 84 (October 14, 2008)
Baseline (August 1, 2002)
Change 85 (October 17, 2008)
Baseline (August 1, 2002)
Change 87 (December 12, 2008)
Baseline (August 1, 2002)
Change 87 (December 12, 2008)
Baseline (August 1, 2002)
Change 87 (December 12, 2008)
Baseline (August 1, 2002)
Change 87 (December 12, 2008)
Baseline (August 1, 2002)
Change 93 (May 29, 2009)
Baseline (August 1, 2002)
Change 133 (June 2, 2011)
Change 93 (May 29, 2009)
Baseline (August 1, 2002)
Change 100 (September 29, 2009)
Baseline (August 1, 2002)
Change 100 (September 29, 2009)
Baseline (August 1, 2002)
Change 123 (December 2, 2010)
Change 101 (October 8, 2009)
Change 100 (September 29, 2009)
Baseline (August 1, 2002)
Change 100 (September 29, 2009)
Baseline (August 1, 2002)
Change 157 (October 15, 2012)
Change 147 (April 5, 2012)
Change 121 (October 19, 2010)
Change 118 (August 9, 2010)
Change 101 (October 8, 2009)
Baseline (August 1, 2002)
Change 104 (November 3, 2009)
Change 102 (October 15, 2009)
Baseline (August 1, 2002)
Change 104 (November 3, 2009)
Baseline (August 1, 2002)
Change 104 (November 3, 2009)
Baseline (August 1, 2002)
Change 108 (December 30, 2009)
Baseline (August 1, 2002)
Change 112 (March 25, 2010)
Baseline (August 1, 2002)
Change 126 (February 2, 2011)
Change 112 (March 25, 2010)
Baseline (August 1, 2002)
Change 141 (September 28, 2011)
Change 133 (June 2, 2011)
Change 112 (March 25, 2010)
Baseline (August 1, 2002)
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