TRICARE Reimbursement Manual 6010.61-M, April 1, 2015 Chapter 13 Outpatient Prospective Payment System (OPPS)-Ambulatory Payment Classification (APC) Revision: Section/Addendum Subject/Addendum Title 1 General 2 Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Figure 13.2-1 PHP As Of CY 2015 Figure 13.2-2 Reporting Of Partial Hospitalization Services Spanning Two Or More Dates - HIPAA 837 Format Figure 13.2-3 Reporting Of Partial Hospitalization Services Spanning Two Or More Dates - CMS 1450 Format 3 Prospective Payment Methodology Figure 13.3-1 Discounting Formulas For Bilateral Procedures Figure 13.3-2 Application of Discounting Formulas Figure 13.3-3 Devices For Which The FB Modifier Must Be Reported With The Procedure When Furnished Without Cost Or At Full Credit For A Replacement Device Figure 13.3-4 Adjustments To APCs In Cases Of Devices Reported Without Cost Or For Which Full Credit Is Received For CY 2009 Figure 13.3-5 Proportional Payment For “T” Line Items 4 Claims Submission And Processing Requirements 5 Medical Review And Allowable Charge Review Under the Outpatient Prospective Payment System (OPPS) A Development Schedule For TRICARE Outpatient Code Editor (OCE)/Ambulatory Payment Classification (APC) Quarterly Update B Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Notification Process For Quarterly Updates C Approval Of OPPS - Outpatient Code Editor (OCE)/APC And No Government Pay List (NGPL) Quarterly Update Process