3.1 Upon
implementation of TRICARE’s Outpatient Prospective Payment System
(OPPS), HCPCS “C” codes shall be paid according to OPPS guidelines
as outlined in the TRICARE Reimbursement Manual (TRM),
Chapter
13. 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, the contractor
shall allow payment of HCPCS “C” codes consistent with current policy
as stated in the TRM,
Chapter 1, Section 24, paragraph 2.2.
3.2 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 U.S. 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.