3.1 Upon
implementation of TRICARE’s Outpatient Prospective Payment System
(OPPS), HCPCS “C” codes shall be paid according to OPPS guidelines
as outlined in the TRICARE Reimbursement Manual (TRM),
Chapter 13. For Hospital Outpatient Department
(HOPD) services provided on or before May 1, 2009 (implementation
of TRICARE’s OPPS), and thereafter, for services by exempt OPPS
hospitals, the contractor shall allow payment of HCPCS “C” codes
consistent with current policy as stated in the TRM,
Chapter 1, Section 24, paragraph 2.2.
3.2 Under
TRICARE, “S” codes are not reimbursable except as follows:
3.2.1 S9122, S9123,
S9124, and S8940 for the Extended Care Health Option (ECHO) respite
care benefit and the ECHO Home Health Care (EHHC) benefit;
3.2.2 S0812, S1030,
S1031, S1040, S2083, S2202, S2235, S2325, S2401 - S2405, S2411,
S3620, S8030, S8185, S8265, S8270, and S9430 for all beneficiaries;
and
3.2.3 S2400 for prenatal surgical intervention
of temporary tracheal occlusion of Congenital Diaphragmatic Hernia
(CDH) for fetuses with prenatal diagnosis of CDH shall be determined
on a case-by-case basis, based on the Rare Disease policy, effective
October 1, 2009. Procedural guidelines for review of rare disease
are contained in
Section 3.1.
3.2.5 S8999 for resuscitation
bag for use by the patient on artificial respiration during power failure
or other catastrophic event. The bag must be U.S. Food and Drug
Administration (FDA) approved, used in accordance with FDA indications,
and must be prescribed by a physician.
3.2.6 S9900 for services rendered by an authorized
Christian Science Practitioner as provided in
Chapter 11, Section 1.1.