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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Mental Health
Chapter 7
Addendum A
Table Of Regional Specific Rates For Psychiatric Hospitals And Units With Low TRICARE Volume - Fiscal Year (FY) 2020 2022 - FY 2022 2024
Revision:  C-83, August 20, 2024
Note:  After Fiscal Year (FY) 2024, TRICARE will publish regional rates, wage index values, and beneficiary cost-shares at https://health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/TRICARE-Health-Plan/Rates-and-Reimbursement/MHSUD-Facility-Rates.
United States Census Regions
FY 2020
Regional Rates
10/01/19 - 09/30/20
FY 2021
Regional Rates
10/01/20 - 09/30/21
FY 2022
Regional Rates
10/01/21 - 09/30/22
Northeast:
New England
(ME, NH, VT, MA, RI, CT)
$9746
$997
$1024
Mid-Atlantic
(NY, NJ, PA)
$939
$963
$988
Midwest:
East North Central
(OH, IN, IL, MI, WI)
$812
$831
$853
West North Central
(MN, IA, MO, ND, SD, NE, KS)
$765
$783
$804
South:
South Atlantic
(DE, MD, DC, VA, WV, NC, SC, GA, FL)
$965
$988
$1015
East South Central
(KY, TN, AL, MS)
$1033
$1058
$1087
West South Central
(AR, LA, TX, OK)
$880
$901
$925
West:
Mountain
(MT, ID, WY, CO, NM, AZ, UT, NV)
$879
$900
$924
Pacific
(WA, OR, CA, AK, HI)
$1039
$1064
$1093
Puerto Rico
$662
$678
$696
UNITED STATES CENSUS REGIONS
FY 2022
REGIONAL RATES
10/01/21 - 09/30/22
FY 2023
REGIONAL RATES
10/01/22 - 09/30/23
FY 2024
REGIONAL RATES
10/01/23 - 09/30/24
NORTHEAST:
New England
(ME, NH, VT, MA, RI, CT)
$1024
$1066
$1101
Mid-Atlantic
(NY, NJ, PA)
$988
$1029
$1063
MIDWEST:
East North Central
(OH, IN, IL, MI, WI)
$853
$888
$917
West North Central
(MN, IA, MO, ND, SD, NE, KS)
$804
$837
$865
SOUTH:
South Atlantic
(DE, MD, DC, VA, WV, NC, SC, GA, FL)
$1015
$1057
$1092
East South Central
(KY, TN, AL, MS)
$1087
$1132
$1169
West South Central
(AR, LA, TX, OK)
$925
$963
$995
WEST:
Mountain
(MT, ID, WY, CO, NM, AZ, UT, NV)
$924
$962
$994
Pacific
(WA, OR, CA, AK, HI)
$1093
$1138
$1176
Puerto Rico
$696
$725
$749
Note:  This table reflects maximum rates.
Wage Index Values
For October 1, 2021 - September 30, 2022: For wage index values greater than 1.0, the wage portion or labor related share subject to the area wage adjustment is 67.6 percent. The non-labor related share is 34.2 percent. For wage index values less than or equal to 1.0, the wage portion or labor related share subject to the area wage adjustment is 62 percent. The non-labor related share is 38 percent. Utilize the appropriate year DRG wage index file for area wage adjustment calculations.
For October 1, 2020 - September 30, 2021: For wage index values greater than 1.0, the wage portion or labor related share subject to the area wage adjustment is 68.3 percent. The non-labor related share is 31.7 percent. For wage index values less than or equal to 1.0, the wage portion or labor related share subject to the area wage adjustment is 62 percent. The non-labor related share is 38 percent. Utilize the appropriate year DRG wage index file for area wage adjustment calculations.
For January 1, 2020 - September 30, 2020: For wage index values greater than 1.0, the wage portion or labor related share subject to the area wage adjustment is 68.3 percent. The non-labor related share is 31.7 percent. For wage index values less than or equal to 1.0, the wage portion or labor related share subject to the area wage adjustment is 62 percent. The non-labor related share is 38 percent. Utilize the appropriate year DRG wage index file for area wage adjustment calculations.
For FY 2020/Beneficiary Cost-Share: Beneficiary cost-share (other than active duty members) for care paid on a basis of a regional per diem rate is the lower of $255 per day or 25 percent of the hospital billed charges effective for services rendered on or after October 1, 2019.
For FY 2021/Beneficiary Cost-Share: Beneficiary cost-share (other than active duty members) for care paid on a basis of a regional per diem rate is the lower of $261 per day or 25 percent of the hospital billed charges effective for services rendered on or after October 1, 2020.
For FY 2022/Beneficiary Cost-Share: Beneficiary cost-share (other than active duty members) for care paid on a basis of a regional per diem rate is the lower of $268 per day or 25 percent of the hospital billed charges effective for services rendered on or after October 1, 2020.
For FYs 2022 through 2024: For wage index values greater than 1.0, the wage portion or labor related share subject to the area wage adjustment is 67.6%. The non-labor related share is 32.4%. For wage index values less than or equal to 1.0, the wage portion or labor related share subject to the area wage adjustment is 62%. The non-labor related share is 38%. Utilize the appropriate year Diagnosis Related Group (DRG) wage index file for area wage adjustment calculations.
For FY 2022/Beneficiary Cost-Share: Beneficiary cost-share (other than active duty members) for care paid on a basis of a regional per diem rate is the lower of $268 per day or 25% of the hospital billed charges effective for services rendered on or after October 1, 2021.
For FY 2023/Beneficiary Cost-Share: Beneficiary cost-share (other than active duty members) for care paid on a basis of a regional per diem rate is the lower of $279 per day or 25% of the hospital billed charges effective for services rendered on or after October 1, 2022.
For FY 2024/Beneficiary Cost-Share: Beneficiary cost-share (other than active duty members) for care paid on a basis of a regional per diem rate is the lower of $288 per day or 25% of the hospital billed charges effective for services rendered on or after October 1, 2023.
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