TRICARE Reimbursement Manual 6010.64-M, April 2021, Change 16 (Jan 8, 2025) Published Change Reimbursement & Coding Update 24-002 Published Date: January 8, 2025 CONREQ:23203 Implementation Date:February 10, 2025 This change is made in conjunction with TRICARE Policy Manual 6010.63-M, April 2021, Change 28 and TRICARE Systems Manual 7950.4-M, April 2021, Change 22. Summary of Changes: This change incorporates T17 published reimbursement and coding changes into the T5 Manuals.Effective Date: As stated in the issuance Affected Sections: Chap 1 Sect 14 -- Ambulance Services Chap 1 Sect 29 -- Reimbursement Of Emergency Inpatient Admissions To Unauthorized Facilities Chap 1 Sect 34 -- Hospital Inpatient Reimbursement In Locations Outside The 50 United States (US) And The District Of Columbia Chap 1 Sect 35 -- Professional Provider Reimbursement In Specified Locations Outside The 50 United States (US) And The District Of Columbia Chap 1 Sect 37 -- Medical Errors Chap 1 Sect 41 -- Temporary Reimbursement Changes In Response To The Coronavirus Disease 2019 (COVID-19) Pandemic Chap 2 Sect 1 -- Cost-Shares And Deductibles For TRICARE Services Received Prior To January 1, 2018 And For TRICARE Services Received On Or After January 1, 2018 By TRICARE For Life (TFL) Beneficiaries Chap 2 Sect 2 -- Cost-Shares And Deductibles For TRICARE Services Received On Or After January 1, 2018 Chap 2 Sect 5 -- Point Of Service (POS) Option Chap 2 Addendum A -- Benefits And Beneficiary Payments Under The TRICARE Program For Services Received Prior To January 1, 2018; And For TRICARE Services Received On Or After January 1, 2018 By TRICARE For Life (TFL) Beneficiaries Chap 3 Sect 1 -- Reimbursement Of Individual Health Care Professionals And Other Non-Institutional Health Care Providers Chap 4 Sect 1 -- Double Coverage Chap 5 Sect 1 -- Providers Chap 5 Sect 3 -- CHAMPUS Maximum Allowable Charges (CMAC) Chap 6 Sect 7 -- Hospital Reimbursement - TRICARE Diagnosis Related Group (DRG)-Based Payment System (Adjusted Standardized Amounts (ASAs)) Chap 6 Sect 8 -- Hospital Reimbursement - TRICARE Diagnosis Related Group (DRG)-Based Payment System (Adjustments To Payment Amounts) Chap 6 Sect 10 -- Hospital Reimbursement - TRICARE Diagnosis Related Group (DRG)-Based Payment System (Charges To Beneficiaries) Chap 6 Sect 12 -- Hospital Reimbursement - Hospital Value-Based Purchasing (HVBP) Chap 6 Addendum B -- TRICARE Adjusted Standardized Amounts (ASAs) - Fiscal Year (FY) 2016 And Beyond Chap 6 Addendum C -- Diagnosis Related Groups (DRGs), DRG Relative Weights, Arithmetic And Geometric Mean Lengths-Of-Stay (LOS), And Short-Stay Outlier Thresholds - FY 2016 And Beyond Chap 7 Addendum B -- Guidelines For The Calculation Of Individual Psychiatric Residential Treatment Center (RTC) Per Diem Rates Chap 8 Sect 1 -- Skilled Nursing Facility (SNF) Prospective Payment System (PPS) For Services Received Prior To October 1, 2019 Chap 9 Sect 1 -- Ambulatory Surgical Center (ASC) Reimbursement For Services Before October 1, 2023 Chap 11 Sect 4 -- Hospice Reimbursement - Coverage/Benefits Chap 11 Addendum A (FY 2019) -- Hospice Care Rates - FY 2019 Chap 11 Addendum A (FY 2020) -- Hospice Care Rates - FY 2020 Chap 11 Addendum A (FY 2021) -- Hospice Care Rates - FY 2021 Chap 11 Addendum A -- Hospice Care Rates Chap 11 Addendum B -- Hospice Rate Information - Hospice Wage Indexes For Urban Areas Chap 11 Addendum C -- Hospice Rate Information - Hospice Wage Indexes For Rural Areas Chap 12 Sect 1 -- Home Health Benefit Coverage And Reimbursement - General Overview Chap 12 Sect 6 -- Home Health Benefit Coverage And Reimbursement - Under The Patient-Driven Groupings Model (PDGM) Chap 12 Sect 7 -- Home Health Benefit Coverage And Reimbursement - Prospective Payment Methodology Chap 12 Addendum C (CY 2021) -- Annual Home Health Agency Prospective Payment System (HHA PPS) Rate Updates - CY 2021 Chap 12 Addendum C (CY 2024) -- Annual Home Health Agency Prospective Payment System (HHA PPS) Rate Updates - CY 2024 Chap 19 Sect 1 -- Freestanding End Stage Renal Disease (ESRD) Facility Reimbursement