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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Operational Requirements
Chapter 3
Section 7
No Government Pay Procedure Codes
Issue Date:  
Authority:  32 CFR 199.2 and 32 CFR 199.6(f)
Copyright:  HCPCS Level I/CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-37, June 18, 2019
1.0  Applicability
This policy is mandatory for reimbursement of services provided by either network or non-network providers.
2.0  Description
This policy provides information on the TRICARE No Government Pay Procedure Code List (NGPL), and clarifies that the NGPL is used as an editing tool only.
3.0  Policy
3.1  The NGPL is an editing tool made available to contractors and the public, which represents Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes most likely to be denied coverage under the TRICARE Basic Program, based on TRICARE statute, regulation and policy. This list is not intended to provide a comprehensive list of all denied items and services, and the information published in the NGPL is subject to change.
3.2  The NGPL does not serve as TRICARE policy. There are other policy or special program provisions (such as rare diseases, demonstration projects, the Extended Care Health Option (ECHO), etc.) that affect coverage and may override the NGPL. Rather, the list shall be used in conjunction with the TRICARE Manuals, which provide clarification and additional services, equipment and supplies that are excluded from coverage under the TRICARE Basic Program.
3.3  The contractors shall not use the NGPL as a denial reason or issue any denial on the basis that a code was on the NGPL, as Appeal rights depend on the reason an item or service was denied.
3.4  For the list of codes on the NGPL, refer to Defense Health Agency’s (DHA’s) website at http://health.mil/Military-Health-Topics/Business-Support/Rates- and-Reimbursement/No-Government-Pay-Procedure-Code-List.
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