Annually,
the Policy and Statistical Analysis Services contractor shall calculate
the U.S. National CMAC rates. The data will contain each CPT code,
a short description, a U.S. National payment rate, as well as the
effective date. On an annual basis, the U.S. 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, paragraph 2.4. 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.