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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Birthing Centers
Chapter 10
Addendum A
Birthing Center Rate Non-Professional Component
Revision:  C-32, February 8, 2019
Figure 10.A-1  2016 Rate YearThese state specific non-professional component amounts are to be used in creating the maximum allowable all-inclusive TRICARE-authorized birthing center prices during the 2012 rate year (i.e., April 1, 2016 - March 31, 2017). The all-inclusive prices are to be updated on April 1st each year to coincide with the Outpatient Prospective Payment System (OPPS) quarterly update. (See Section 1, for instruction for the use of these amounts.)
2016 Rate Year
TRICARE-Authorized Birthing Center Provider
Non-Professional Component For All-Inclusive Pricing Formula
Alabama
$4,324.06
Montana
$2,989.28
Alaska
$5,199.64
Nebraska
$3,208.72
Arizona
$3,314.39
Nevada
$6,377.82
Arkansas
$7,088.18
New Hampshire
$4,397.25
California
$5,545.26
New Jersey
$5,553.59
Colorado
$4,250.03
New Mexico
$4,193.49
Connecticut
$6,313.36
New York
$2,323.34
Delaware
$4,720.91
North Carolina
$4,026.43
District of Columbia
$7,059.48
North Dakota
$2,654.37
Florida
$5,282.39
Ohio
$5,180.16
Georgia
$4,884.28
Oklahoma
$4,422.62
Hawaii
$3,658.48
Oregon
$2,954.86
Idaho
$3,983.03
Pennsylvania
$4,770.33
Illinois
$4,268.78
Puerto Rico
$868.89
Indiana
$4,892.74
Rhode Island
$5,139.17
Iowa
$3,923.07
South Carolina
$4,676.38
Kansas
$5,179.01
South Dakota
$2,556.59
Kentucky
$3,287.92
Tennessee
$3,631.33
Louisiana
$3,414.76
Texas
$4,425.49
Maine
$4,175.41
Utah
$2,377.76
Maryland
$3,254.58
Vermont
$3,493.23
Massachusetts
$4,532.72
Virginia
$3,433.93
Michigan
$3,554.68
Washington
$3,672.69
Minnesota
$4,026.35
West Virginia
$2,913.36
Mississippi
$5,322.57
Wisconsin
$3,126.70
Missouri
$4,170.78
Wyoming
$4,937.25
Figure 10.A-2  2017 Rate YearThese state specific non-professional component amounts are to be used in creating the maximum allowable all-inclusive TRICARE-authorized birthing center prices during the 2017 rate year (i.e., April 1, 2017 - March 31, 2018). The all-inclusive prices are to be updated on April 1st each year to coincide with the Outpatient Prospective Payment System (OPPS) quarterly update. (See Section 1, for instruction for the use of these amounts.)
2017 Rate Year
TRICARE-Authorized Birthing Center Provider
Non-Professional Component For All-Inclusive Pricing Formula
Alabama
$4,498.83
Montana
$3,156.29
Alaska
$4,823.88
Nebraska
$3,072.27
Arizona
$3,393.89
Nevada
$6,760.56
Arkansas
$7,072.78
New Hampshire
$4,369.86
California
$5,762.19
New Jersey
$5,336.08
Colorado
$4,524.52
New Mexico
$4,239.63
Connecticut
$6,751.59
New York
$2,612.86
Delaware
$5,133.16
North Carolina
$4,405.72
District of Columbia
$7,274.87
North Dakota
$3,100.27
Florida
$5,595.41
Ohio
$5,428.50
Georgia
$5,249.76
Oklahoma
$4,631.94
Hawaii
$3,744.24
Oregon
$2,893.58
Idaho
$4,015.52
Pennsylvania
$5,086.33
Illinois
$4,392.88
Puerto Rico
$658.00
Indiana
$5,253.38
Rhode Island
$4,725.58
Iowa
$4,368.57
South Carolina
$5,020.77
Kansas
$5,362.90
South Dakota
$2,747.16
Kentucky
$3,413.35
Tennessee
$3,728.32
Louisiana
$3,741.41
Texas
$4,699.01
Maine
$3,586.18
Utah
$2,572.90
Maryland
$3,466.07
Vermont
$3,768.11
Massachusetts
$4,443.08
Virginia
$3,554.41
Michigan
$3,895.53
Washington
$4,036.80
Minnesota
$4,277.05
West Virginia
$2,694.33
Mississippi
$5,737.93
Wisconsin
$3,091.87
Missouri
$4,324.98
Wyoming
$4,915.51
2018 RATE YEAR AND BEYOND
For services provided on or after April 1, 2018, the non-professional component or facility component of the birthing center all-inclusive rate is now the one-day Diagnosis Related Group (DRG) Short-Stay Outlier (SSO) for DRG 775 (uncomplicated vaginal birth) adjusted for geographic cost variations. Since DRG 775 has been deleted by the Centers for Medicare and Medicaid Services (CMS) starting in Fiscal Year (FY) 2019, Defense Health Agency (DHA) is replacing DRG 775 with the one-day SSO for DRG 807 (uncomplicated vaginal birth without sterilization/D&C) adjusted for geographic cost variations, effective for service dates on or after October 1, 2018. The DRG zip-to-wage index files shall be used for adjusting the facility component rate for geographical labor cost variations. The FY 2018 and FY 2019 DRG rates are available on the DRG Rates page of the Military Health System (MHS) web site at https://health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/Diagnosis-Related-Group-Rates. The birthing center rates information for subsequent future FYs will no longer be published in this manual (Chapter 10, Addendum A) since the rates are located on the DRG Rates page of the MHS web site.
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