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3.1  The NGPL is an editing tool made available to contractors and the public, which represents Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes most likely to be denied coverage under the TRICARE Basic Program, based on TRICARE statute, regulation and policy. This list is not intended to provide a comprehensive list of all denied items and services, and the information published in the NGPL is subject to change.

3.2  The NGPL does not serve as TRICARE policy. There are other policy or special program provisions (such as rare diseases, demonstration projects, the Extended Care Health Option (ECHO)) that affect coverage and may override the NGPL. Rather, the list shall be used in conjunction with the TRICARE Manuals, which provide clarification and additional services, equipment and supplies that are excluded from coverage under the TRICARE Basic Program.

3.3  The contractors shall not use the NGPL as a denial reason or issue any denial on the basis that a code was on the NGPL, as Appeal rights depend on the reason an item or service was denied.

3.4  For the list of codes on the NGPL, refer to Defense Health Agency’s (DHA’s) website at http://health.mil/Military-Health-Topics/Business-Support/Rates- and-Reimbursement/No-Government-Pay-Procedure-Code-List.

3.5  The contractor shall notify the Contracting Officer’s Representative (COR), within five business days, in cases of perceived or actual discrepancies between the NGPL and TRICARE policy. In such cases, the TRICARE Manuals, regulation, and statute take precedence over the NGPL.