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.