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TRICARE Reimbursement Manual 6010.64-M, April 2021
General
Chapter 1
Section 34
Hospital Inpatient Reimbursement In Locations Outside The 50 United States (US) And The District Of Columbia
Issue Date:  September 9, 2004
Authority:  32 CFR 199.1(b) and 32 CFR 199.14(m), (n), and (o)
Revision:  C-6, August 7, 2024
1.0  APPLICABILITY
The TRICARE Overseas Program (TOP) contractor shall apply this policy for reimbursement of all hospital inpatient services provided in the locations identified in paragraph 4.2. This policy revises, replaces, and supersedes the previously issued policy, effective October 1, 2004, for hospital reimbursement in the Philippines. Puerto Rico follows Continental United States (CONUS) based reimbursement methodologies used for the 50 US and the District of Columbia.
2.0  ISSUE
How are specified inpatient hospital services reimbursed in the locations specified in paragraph 4.2?
3.0  POLICY
The institutional per diem for those specified locations outside the 50 US and the District of Columbia is the maximum amount TRICARE will authorize to be paid for inpatient services on a per diem basis. The TOP contractor shall ensure its allowable institutional rates for those specified locations outside the 50 US and the District of Columbia, are the lesser of (a) billed charges or; (b) the amount based on prospectively determined per diems which are adjusted by a country specific index factor.
4.0  BACKGROUND
Reimbursement Systems:
4.1  General
4.1.1  The TOP contractor shall make payment for inpatient hospital stays in specified locations outside the 50 US and the District of Columbia, using the lesser of:
•  Billed charges; or
•  The prospectively determined per diems adjusted by a country specific index.
4.1.2  The prospectively determined per diem rates for specified locations outside the 50 US and the District of Columbia, are developed into reimbursement groupings by using diagnosis codes. The TOP contractor shall use diagnosis codes as contained in the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). The per diem rates are the maximum allowable amounts that TRICARE shall reimburse and the amount on which patient cost-shares are calculated. The National US per diem rate is multiplied by a unique country specific index factor which adjusts the National US per diems for the applicable country. The country specific hospital per diem, for those specified locations outside the 50 US and the District of Columbia is the product of the National US per diem and the country specific index.
4.2  Applicability
4.2.1  The TOP contractor shall apply this payment system to all hospitals providing services in:
•  The Philippines.
•  Panama.
•  Other as designated by the Government.
4.2.2  The TOP contractor shall apply this payment system to hospital inpatient services furnished to retirees or their eligible family members or non-Prime Active Duty Family Members (ADFMs) falling under the claims processing jurisdiction of the TOP contractor.
4.2.3  The TOP contractor shall ensure institutional providers accepting, admitting and treating TRICARE beneficiaries receive the per diem reimbursement on applicable hospital services included on inpatient claims. The TOP contractor shall use this payment system regardless of the type of hospital inpatient services provided. The prospectively determined per diem rates established under this system are all-inclusive and are intended to include, but not be limited to:
•  A standard amount for nursing and technician services;
•  Room, board and meals;
•  Drugs including any take home drugs;
•  Biologicals; surgical dressings, splints, casts;
•  Durable Medical Equipment (DME) for use in the hospital and is related to the provision of a surgical service, procedure or procedures, equipment related to the provision and performance of surgical procedures; laboratory services and testing; x-ray or other diagnostic procedures directly related to the inpatient Episode Of Care (EOC);
•  Special unit operating costs, such as intensive care units; malpractice costs, if applicable, or other administrative costs related to the services furnished to the patients, recordkeeping and the provision of records;
•  Housekeeping items and services; and
•  Capital costs.
4.2.4  The per diem rates do not include such items as physicians’ fees, irrespective of a physician’s employment status with the hospital. The per diem rates do not include other professional providers (e.g., nurse anesthetist) recognized by TRICARE who render directly related inpatient services and bill independently from the hospital for them. The TOP contractor shall ensure the hospital or institutional provider submits a valid primary ICD-10-CM code or narrative description of services. The TOP contractor shall ensure the medical description supports development of the claim prior to reimbursement.
4.3  Country Specific Index
The country specific index is a factor obtained from the World Bank’s International Comparison Program. The index factor, known as Purchasing Power Parity (PPP) conversion factor, is based on a large array of goods and services or market basket within the specific country which is then standardized and weighted to a US standard and currency. The World Bank defines PPP conversion factor as: “Number of units of a country’s currency required to buy the same amount of goods and services in the domestic market that a US dollar would buy in the US.” The use of the country specific index enables a conversion and therefore creates parity between the US and the specific country in the purchasing of the same amount and type of medical services. TRICARE uses the World Bank’s International Comparison Program country specific index as provided in Figure 1.34-1.
4.4  Institutional Payment Rates
4.4.1  The TOP contractor shall use the national adjusted per diems in Figure 1.34-2. The figures contain the ICD-10-CM code, code range, or groups of related diagnosis codes. The first alpha character and two digits of the principal ICD-10-CM diagnosis code determines placement into a diagnosis group as well as a reimbursement group. The adjusted per diems will be available at: http://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/Foreign-Rates https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/Foreign-Rates.
4.4.2  The rate setting methodology was developed as follows:
•  Used the first alpha character and two digits of a primary diagnosis code.
•  Eighteen diagnosis groupings were defined and designed based on the groupings and definitions contained in the ICD-10-CM publication. For example, Group 1 is defined as ICD-10-CM codes A00 to B99, or Infectious and Parasitic Diseases. The first alpha character and two digits of a primary diagnosis code are used for placement into one of the 18 groups.
•  The payment rate for each of the 18 diagnostic groups was the average allowed amount per day over all the ICD-10-CM codes in a diagnosis group, based upon the claim’s primary diagnosis, plus an add-on to reimburse for capital costs.
•  Group payments were calculated by dividing total allowed charges by total inpatient days for the group.
•  Once the 18 groupings were defined, certain unique admissions were identified for reimbursement separately from the 18 groupings. These are listed in Figure 1.34-3 available at https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/Foreign-Rates.
4.5  Payments
4.5.1  General. The TOP contractor shall base the per diem group payment rate on the first alpha character and two digits of the primary diagnosis code. For hospital inpatient care, the TOP contractor shall reimburse the lesser of:
•  Actual billed charges for hospital inpatient care; or
•  The US National per diem rate authorized under TRICARE, multiplied by the country specific index factor, is the country specific hospital per diem. The TOP contractor shall multiply this per diem by the number of covered days of hospital inpatient care. This equals the maximum amount allowed by TRICARE to be paid for the episode on inpatient care.
4.5.2  The TOP contractor shall take only the primary diagnosis code, on the date of admission, into consideration when determining the group for a payment rate. The TOP contractor shall assign only one payment group to each independent episode of inpatient care. The contractor shall ensure each institutional claim for service reimbursement contains a valid ICD-10-CM code or narrative description of services, and that it is used to represent the primary diagnosis for inpatient admission. If a valid diagnosis code or narrative description is not supplied by the institutional provider, the TOP contractor shall develop one with supporting documentation. The TOP contractor shall ensure development of an institutional claim results in providing the necessary elements to satisfy TRICARE Encounter Data (TED) record requirements.
4.6  Beneficiary - Change in Eligibility Status
Since payment is on a per diem basis, the TOP contractor shall pay hospital claims for services for the days the beneficiary is TRICARE eligible and the TOP contractor shall deny claims for the days the beneficiary is not TRICARE eligible.
4.7  Beneficiary Cost-Shares
The TOP contractor shall apply inpatient cost-shares as contained in Chapter 2, Section 1, for non-Diagnosis Related Group (DRG) facilities to the hospital allowable charge authorized under TRICARE.
4.8  Updating Payment Rates
4.8.1  DHA will communicate additions, changes, revisions, or deletions to the diagnosis codes or country specific index to the TOP contractor and the TOP contractor shall consider these as routine updates to this payment system and process them under TRICARE Operations Manual (TOM), Chapter 1, Section 4.
4.8.2  DHA will update inpatient per diem rates for Panama and the Philippines annually in conjunction with the TRICARE DRG update in the US.
4.9  The TOP contractor shall maintain the current year and two immediate past years’ iterations of the US National per diems authorized under TRICARE and the country specific index factors.
4.10  There is no TRICARE waiver process applicable to hospitals in specified locations outside the 50 US and the District of Columbia for institutional inpatient rates.
Figure 1.34-1  Country Specific Index Factors
Country Specific Index Factor
Effective
2008
Philippines
0.52
November 1, 2008
Panama
0.70
February 1, 2009
2012
Philippines
0.57
December 1, 2012
Panama
0.70
December 1, 2012
Figure 1.34-2  Institutional Inpatient Diagnostic Groupings For Specified Locations Outside The 50 US And The District Of Columbia - National Inpatient Per Diem Amounts
Group
Description
ICD-9-CM Code Range
(FOR SERVICES BEFORE the mandated date, as directed by HHS, for ICD-10 implementation)
ICD-10-CM CODE RANGE
(FOR SERVICES ON OR AFTER the mandated date, as directed by HHS, for ICD-10 implementation)
National Inpatient Per Diem
Note:   Care delivered must be a benefit of TRICARE under 32 CFR 199.4 and 199.5 .
October 1, 2018
01
Infectious Disease
1 - 139
A00 - B99
$2,674
02
Cancer
140 - 239
C00 - D49
$4,107
03
Endocrine
240 - 289
D50 - D89, E00 - E89
$3,410
04
Mental health
290 - 319
F01 - F99
$1,078
05
Nervous System
320 - 389
G00 - G99, H00 - H95
$2,819
06
Circulatory
390 - 459
I00 - I99
$4,185
07
Respiratory
460 - 519
J00 - J99
$2,242
08
Digestive
520 - 579
K00 - K95
$2,615
09
Genitourinary
580 - 629
N00 - N99
$2,692
10
Pregnancy, birth (mother)
630 - 679, V22 - V24, V27
O00 - O9A, Z33, Z34, Z36, Z37, Z39
$1,785
11
Musculoskeletal and skin
680 - 739
L00 - L99, M00 - M99
$6,765
12
Congenital abnormalities
740 - 759
Q00 - Q99
$5,117
13
Perinatal Fetus and infant
760 - 779, V21, V29 - V39
P00 - P96, Z3A, Z38
$1,247
14
Signs, Symptoms, etc.
780 - 799
R00 - R99
$2,449
15
Injuries
800 - 959
S00 - T34
$3,968
16
Poisoning
960 - 996
T36 - T79
$2,340
17
Complications
996 - 999
T80 - T88
$3,818
18
All other codes
$3,026
October 1, 2019
01
Infectious Disease
1 - 139
A00 - B99
$2,821
02
Cancer
140 - 239
C00 - D49
$4,319
03
Endocrine
240 - 289
D50 - D89, E00 - E89
$3,560
04
Mental health
290 - 319
F01 - F99
$1,167
05
Nervous System
320 - 389
G00 - G99, H00 - H95
$2,911
06
Circulatory
390 - 459
I00 - I99
$4,428
07
Respiratory
460 - 519
J00 - J99
$2,356
08
Digestive
520 - 579
K00 - K95
$2,742
09
Genitourinary
580 - 629
N00 - N99
$2,914
10
Pregnancy, birth (mother)
630 - 679, V22 - V24, V27
O00 - O9A, Z33, Z34, Z36, Z37, Z39
$1,833
11
Musculoskeletal and skin
680 - 739
L00 - L99, M00 - M99
$7,521
12
Congenital abnormalities
740 - 759
Q00 - Q99
$5,319
13
Perinatal Fetus and infant
760 - 779, V21, V29 - V39
P00 - P96, Z3A, Z38
$1,317
14
Signs, Symptoms, etc.
780 - 799
R00 - R99
$2,597
15
Injuries
800 - 959
S00 - T34
$4,250
16
Poisoning
960 - 996
T36 - T79
$2,726
17
Complications
996 - 999
T80 - T88
$3,996
18
All other codes
$2,868
October 1, 2020
01
Infectious Disease
1 - 139
A00 - B99
$3,057
02
Cancer
140 - 239
C00 - D49
$4,694
03
Endocrine
240 - 289
D50 - D89, E00 - E89
$3,658
04
Mental health
290 - 319
F01 - F99
$1,326
05
Nervous System
320 - 389
G00 - G99, H00 - H95
$3,217
06
Circulatory
390 - 459
I00 - I99
$4,645
07
Respiratory
460 - 519
J00 - J99
$2,409
08
Digestive
520 - 579
K00 - K95
$2,877
09
Genitourinary
580 - 629
N00 - N99
$2,982
10
Pregnancy, birth (mother)
630 - 679, V22 - V24, V27
O00 - O9A, Z33, Z34, Z36, Z37, Z39
$1,978
11
Musculoskeletal and skin
680 - 739
L00 - L99, M00 - M99
$8,021
12
Congenital abnormalities
740 - 759
Q00 - Q99
$6,619
13
Perinatal Fetus and infant
760 - 779, V21, V29 - V39
P00 - P96, Z3A, Z38
$1,518
14
Signs, Symptoms, etc.
780 - 799
R00 - R99
$2,706
15
Injuries
800 - 959
S00 - T34
$4,635
16
Poisoning
960 - 996
T36 - T79
$2,780
17
Complications
996 - 999
T80 - T88
$4,077
18
All other codes
$3,210
Figure 1.34-3  Unique Admissions - National Inpatient Per Diem Amounts
Description
ICD-9-CM Code
(For Services before the mandated date, as directed by HHS, for ICD-10 implementation)
ICD-10-CM Code
(For Services on or after the mandated date, as directed by HHS, for ICD-10 implementation)
National Inpatient Per Diem
Note:   Care delivered must be a benefit of TRICARE under 32 CFR 199.4 and 199.5.
October 1, 2018
Heart Transplant
V42.1
Z94.1
$9,228
Kidney Transplant
V42.0
Z94.0
$7,557
Combined Small Intestine/Liver (SI/L) Transplant
V42.7
Z94.4
$6,153
Lung Transplant
V42.6
Z94.2
$5,555
Simultaneous Pancreas-Kidney (SPK) Transplant
V42.89
Z94.89
$4,704
Pancreas Transplant
V42.83
Z94.83
$6,923
Coronary Artery Bypass Grafts (CABG)
V43.4
Z95.828
$5,568
Coronary Bypass with Percutaneous Transluminal Coronary Angioplasty (PTCA)
V45.82
Z98.61
$6,631
October 1, 2019
Heart Transplant
V42.1
Z94.1
$9,178
Kidney Transplant
V42.0
Z94.0
$7,145
Combined SI/L Transplant
V42.7
Z94.4
$7,774
Lung Transplant
V42.6
Z94.2
$5,437
SPK Transplant
V42.89
Z94.89
$5,657
Pancreas Transplant
V42.83
Z94.83
$6,984
CABG
V43.4
Z95.828
$6,077
Coronary Bypass with PTCA
V45.82
Z98.61
$8,455
October 1, 2020
Heart Transplant
V42.1
Z94.1
$9,331
Kidney Transplant
V42.0
Z94.0
$8,354
Combined Small Intestine/Liver (SI/L) Transplant
V42.7
Z94.4
$8,384
Lung Transplant
V42.6
Z94.2
$5,505
Simultaneous Pancreas-Kidney (SPK) Transplant
V42.89
Z94.89
$5,965
Pancreas Transplant
V42.83
Z94.83
$7,365
Coronary Artery Bypass Grafts (CABG)
V43.4
Z95.828
$6,665
Coronary Bypass with Percutaneous Transluminal Coronary Angioplasty (PTCA
V45.82
Z98.61
$7,933
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