3.0 Policy
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.
3.5 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.