TRICARE Manuals - Published Change

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 - Guidelines For Payment Of Designated Levels Of Care
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 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
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