Back to Top Skip to main content

Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Diagnosis Related Groups (DRGs)
Chapter 6
Section 9
Hospital Reimbursement - TRICARE Diagnosis Related Group (DRG)-Based Payment System (Information Provided By Defense Health Agency (DHA))
Issue Date:  October 8, 1987
Authority:  32 CFR 199.14(a)(1)
Revision:  C-44, December 13, 2019
1.0  ISSUE
What information will be provided by the DHA concerning the TRICARE DRG-based payment system?
2.0  POLICY
2.1  Information provided by DHA. The following specific data, which is necessary to determine the payment amount under the TRICARE DRG-based payment system, will be provided to the contractors by DHA. Updates to these data will be provided in accordance with the TRICARE Program plan year.
2.1.1  DRG weighting factors.
2.1.2  Adjusted Standardized Amounts (ASAs) (urban and rural), including the labor-related and nonlabor-related portions.
2.1.3  Area wage indexes.
2.1.4  Outlier cutoffs for each DRG.
2.1.5  Geometric mean Length-Of-Stay (LOS) for each DRG.
2.1.6  Per diem cost-share for beneficiaries other than dependents of active duty members.
2.1.7  Children’s hospital differentials (national and hospital-specific).
2.1.8  The ratio of interns and residents to beds for those hospitals subject to the Medicare Prospective Payment System (PPS), as listed in Centers for Medicare and Medicaid Services’ (CMSs’) most recently available Provider Specific File.
2.1.9  The Indirect Medical Education (IDME) factors for all hospitals subject to the TRICARE DRG-based payment system.
2.2  DHA will provide the contractors with corrected wage indexes when applicable.
- END -

Utility Navigation Links

DoD Seal

tricare.mil is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.

v4.11.8372.15705

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.