Annually,
the Policy and Statistical Analysis Services contractor shall calculate
the US National CMAC rates. The data will contain each CPT code,
a short description, a US National payment rate, as well as the
effective date. On an annual basis, the US National CMAC may increase
or decrease as determined by TRICARE. This contractor shall separately
supply to the Defense Health Agency (DHA) the country specific index
every year or as dictated by the World Bank’s International Comparison
program or as determined by TRICARE, which will be included in
Figure 1.35-1.
The above contractor shall also provide the country specific index
adjusted CMAC files, and any updates or corrections, electronically
to DHA, which will be provided to the overseas claims processor
at least annually, or as specifics may dictate. For those codes
that contain a technical as well as professional component, each
component shall have a separate supplied payment rate. Updates,
additions, changes, revisions or deletions to the CPT codes or country
specific index or CMACs will be communicated to the overseas claims
processor and shall be considered as routine updates to this payment
system and processed under TRICARE Operations Manual (TOM),
Chapter 1, Section 4. 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.