3.1 HCPCS
“C” Codes
3.1.1 The
contractor shall pay HCPCS
C codes according to the
Outpatient Prospective Payment System (OPPS) guidelines as outlined
in the TRICARE Reimbursement Manual (TRM),
Chapter
13.
3.1.2 The contractor
shall allow payment for HCPCS
C codes, 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, consistent with current policy
as stated in the TRM,
Chapter 1, Section 24.
3.2 HCPCS “S” Codes
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 United States (US)
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.