TRICARE Reimbursement Manual 6010.61-M, April 1, 2015 Chapter 1 General Revision: C-35, March 19, 2019 Section/Addendum Subject/Addendum Title 1 Network Provider Reimbursement 2 Accommodation Of Discounts Under Provider Reimbursement Methods 3 Claims Auditing Software 4 Reimbursement In Teaching Setting 5 National Health Service Corps (NHSC) Physicians Of The Public Health Service (PHS) 6 Reimbursement Of Physician Assistants (PAs), Nurse Practitioners (NPs), And Certified Psychiatric Nurse Specialists (CPNSs) 7 Reimbursement Of Covered Services Provided By Individual Health Care Providers And Other Non-Institutional Health Care Providers 8 Economic Interest In Connection With Mental Health Admissions 9 Anesthesia 10 Postoperative Pain Management - Epidural Analgesia 11 Claims For Durable Equipment (DE) And Durable Medical Equipment, Prosthetics, Orthotics, And Supplies (DMEPOS) 12 Oxygen And Related Supplies 13 Laboratory Services 14 Ambulance Services Figure 1.14-1 Ground Ambulance Scenarios In Which The Beneficiary Dies Figure 1.14-2 Air Ambulance Scenarios in Which The Beneficiary Dies Figure 1.14-3 Air Ambulance Scenarios in Which The Flight is Aborted 15 Legend Drugs And Insulin 16 Surgery 17 Assistant Surgeons 18 Professional Services: Obstetrical Care 19 Charges For Provider Administrative Expenses 20 State Agency Billing 21 Hospital Reimbursement - Billed Charges Set Rates 22 Hospital Reimbursement - Other Than Billed Charges 23 Hospital Reimbursement - Payment When Only Skilled Nursing Facility (SNF) Level Of Care Is Required 24 Hospital Reimbursement - Outpatient Services 25 Preferred Provider Organization (PPO) Reimbursement 26 Supplemental Insurance 27 Legal Obligation To Pay 28 Reduction Of Payment For Noncompliance With Utilization Review Requirements 29 Reimbursement Of Emergency Inpatient Admissions To Unauthorized Facilities 30 Reimbursement Of Travel Expenses For Specialty Care 31 Newborn Charges 32 Hospital-Based Birthing Room 33 Bonus Payments In Health Professional Shortage Areas (HPSAs) 34 Hospital Inpatient Reimbursement In Locations Outside The 50 United States (U.S.) And The District Of Columbia Figure 1.34-1 Country Specific Index Factors Figure 1.34-2 Institutional Inpatient Diagnostic Groupings For Specified Locations Outside The 50 U.S. And The District Of Columbia - National Inpatient Per Diem Amounts Figure 1.34-3 Unique Admissions - National Inpatient Per Diem Amounts 35 Professional Provider Reimbursement In Specified Locations Outside The 50 United States (U.S.) And The District Of Columbia Figure 1.35-1 Country Specific Index Factors 36 Forensic Examinations Following Sexual Assault or Domestic Violence 37 Medical Errors 38 Reimbursement of State Vaccine Programs (SVPs) 39 CHAMPUS Maximum Allowable Charge (CMAC) For Banked Donor Milk (BDM) A Sample State Agency Billing Agreement B Figures Figure 1.B-1 Suggested Wording To The Beneficiary Concerning Rental vs. Purchase Of Durable Medical Equipment (DME) C Minimum Requirements For Reimbursement Of Per Capita State (Or Alternative) State Vaccine Programs (SVPs) D Maximum Allowable Charge For Breastfeeding Supplies Figure 1.D-1 National Prevailing Charge For Breastfeeding Supplies With A Specific HCPCS Code For Service Dates On Or After July 5, 2018 Figure 1.D-2 TOP National Prevailing Charge For Breastfeeding Supplies With A Specific HCPCS Code For Service Dates On Or After July 5, 2018 Figure 1.D-3 National Prevailing Charge For Breastfeeding Supplies Without A Specific HCPCS Code For Service Dates On Or After July 5, 2018 Figure 1.D-4 TOP National Prevailing Charge For Breastfeeding Supplies Without A Specific HCPCS Code For Service Dates On Or After July 5, 2018