3.0 Policy3.1 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), etc.) 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.