Manual Table of Contents

TRICARE/CHAMPUS Policy Manual 6010.47-M, May 1996, Change 25 (July 2, 2001)

  1. Collapse to hide TRICARE/CHAMPUS Policy Manual contentsManualTRICARE/CHAMPUS Policy Manual 6010.47-M, May 1996
    1. PDF FilePOL TOC (TRICARE/CHAMPUS Policy Manual)
    2. PDF FilePOL Foreword (TRICARE/CHAMPUS Policy Manual)
    3. PDF FilePOL Introduction (TRICARE/CHAMPUS Policy Manual)
    4. Expand to show POL Chap 1 TOC contentsPDF FilePOL Chap 1 TOC -- Medical Services (TRICARE/CHAMPUS Policy Manual)
      1. Expand to show POL Chap 2 TOC contentsPDF FilePOL Chap 2 TOC -- Anesthesia (TRICARE/CHAMPUS Policy Manual)
        1. Expand to show POL Chap 3 TOC contentsPDF FilePOL Chap 3 TOC --Surgery And Related Services (TRICARE/CHAMPUS Policy Manual)
          1. Expand to show POL Chap 4 TOC contentsPDF FilePOL Chap 4 TOC --Radiology (TRICARE/CHAMPUS Policy Manual)
            1. Expand to show POL Chap 5 TOC contentsPDF FilePOL Chap 5 TOC --Pathology And Laboratory Services (TRICARE/CHAMPUS Policy Manual)
              1. Expand to show POL Chap 6 TOC contentsPDF FilePOL Chap 6 TOC --Institutional Services (TRICARE/CHAMPUS Policy Manual)
                1. Expand to show POL Chap 7 TOC contentsPDF FilePOL Chap 7 TOC --Other Services (TRICARE/CHAMPUS Policy Manual)
                  1. Expand to show POL Chap 8 TOC contentsPDF FilePOL Chap 8 TOC --Program For Persons With Disabilities (TRICARE/CHAMPUS Policy Manual)
                    1. Expand to show POL Chap 9 TOC contentsPDF FilePOL Chap 9 TOC --Eligibility And Enrollment (TRICARE/CHAMPUS Policy Manual)
                      1. Expand to show POL Chap 10 TOC contentsPDF FilePOL Chap 10 TOC --Provider Policy (TRICARE/CHAMPUS Policy Manual)
                        1. Expand to show POL Chap 11 TOC contentsPDF FilePOL Chap 11 TOC --Administrative Policy (TRICARE/CHAMPUS Policy Manual)
                          1. Expand to show POL Chap 12 TOC contentsPDF FilePOL Chap 12 TOC --TRICARE Overseas Program (TOP) (TRICARE/CHAMPUS Policy Manual)
                            1. Collapse to hide POL Chap 13 TOC contentsPDF FilePOL Chap 13 TOC --Payments Policy (TRICARE/CHAMPUS Policy Manual)
                              1. PDF FilePOL Chap 13 Sect 1.1 -- Network Provider Reimbursement (Tricare/CHAMPUS Policy Manual)
                              2. PDF FilePOL Chap 13 Sect 1.2 -- Allowable Charges - Non-Network Providers (Tricare/CHAMPUS Policy Manual)
                              3. PDF FilePOL Chap 13 Sect 1.3 -- Allowable Charges - CHAMPUS Maximum Allowable Charges (CMAC) (Tricare/CHAMPUS Policy Manual)
                              4. PDF FilePOL Chap 13 Sect 1.4 -- Rebundling Of Procedure Codes (Tricare/CHAMPUS Policy Manual)
                              5. PDF FilePOL Chap 13 Sect 2.1 -- Reimbursement In Teaching Setting (Tricare/CHAMPUS Policy Manual)
                              6. PDF FilePOL Chap 13 Sect 2.2 -- National Health Service Corps Physicians Of The Public Health Service (Tricare/CHAMPUS Policy Manual)
                              7. PDF FilePOL Chap 13 Sect 2.5 -- Reimbursement Of Physician Assistants (Tricare/CHAMPUS Policy Manual)
                              8. PDF FilePOL Chap 13 Sect 2.6 -- Reimbursement Of Covered Services Provided By Individual Health-Care Professionals And Other Non-Institutional Health-Care Providers (Tricare/CHAMPUS Policy Manual)
                              9. PDF FilePOL Chap 13 Sect 2.7 -- Economic Interest In Connection With Mental Health Admissions (Tricare/CHAMPUS Policy Manual)
                              10. PDF FilePOL Chap 13 Sect 3.1 -- Anesthesia (Tricare/CHAMPUS Policy Manual)
                              11. PDF FilePOL Chap 13 Sect 3.1A -- Postoperative Pain Management (Tricare/CHAMPUS Policy Manual)
                              12. PDF FilePOL Chap 13 Sect 3.2 -- Durable Medical Equipment Claims: Basic Program (Tricare/CHAMPUS Policy Manual)
                              13. PDF FilePOL Chap 13 Sect 3.3 -- Oxygen And Related Supplies (Tricare/CHAMPUS Policy Manual)
                              14. PDF FilePOL Chap 13 Sect 3.4 -- Laboratory Services (Tricare/CHAMPUS Policy Manual)
                              15. PDF FilePOL Chap 13 Sect 3.5 -- Ambulance Services (Tricare/CHAMPUS Policy Manual)
                              16. PDF FilePOL Chap 13 Sect 3.6 -- Legend Drugs And Insulin (Tricare/CHAMPUS Policy Manual)
                              17. PDF FilePOL Chap 13 Sect 3.7 -- Surgery (Tricare/CHAMPUS Policy Manual)
                              18. PDF FilePOL Chap 13 Sect 3.7A -- Assistant Surgeons (Tricare/CHAMPUS Policy Manual)
                              19. PDF FilePOL Chap 13 Sect 3.8 -- Professional Services: Obstetrical Care (Tricare/CHAMPUS Policy Manual)
                              20. PDF FilePOL Chap 13 Sect 3.9 -- Birthing Center Reimbursement (Tricare/CHAMPUS Policy Manual)
                              21. PDF FilePOL Chap 13 Sect 3.10 -- Skilled Nursing Services (Tricare/CHAMPUS Policy Manual)
                              22. PDF FilePOL Chap 13 Sect 4.1 -- Individual Consideration Cases (Tricare/CHAMPUS Policy Manual)
                              23. PDF FilePOL Chap 13 Sect 4.2 -- Charges For Provider Administrative Expenses (Tricare/CHAMPUS Policy Manual)
                              24. PDF FilePOL Chap 13 Sect 4.4 -- Payment For Professional/Technical Components Of Diagnostic Services (Tricare/CHAMPUS Policy Manual)
                              25. Expand to show POL Chap 13 Sect 5.1 contentsPDF FilePOL Chap 13 Sect 5.1 -- State Agency Billing (Tricare/CHAMPUS Policy Manual)
                                1. PDF FilePOL Chap 13 Sect 6.1A -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (General) (Tricare/CHAMPUS Policy Manual)
                                2. PDF FilePOL Chap 13 Sect 6.1B -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (General Description Of System) (Tricare/CHAMPUS Policy Manual)
                                3. PDF FilePOL Chap 13 Sect 6.1C -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Basis Of Payment) (Tricare/CHAMPUS Policy Manual)
                                4. PDF FilePOL Chap 13 Sect 6.1D -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Applicability Of The DRG System) (Tricare/CHAMPUS Policy Manual)
                                5. PDF FilePOL Chap 13 Sect 6.1E -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Determination Of Payment Amounts) (Tricare/CHAMPUS Policy Manual)
                                6. PDF FilePOL Chap 13 Sect 6.1F -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (DRG Weighting Factors) (Tricare/CHAMPUS Policy Manual)
                                7. PDF FilePOL Chap 13 Sect 6.1G -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Adjusted Standardized Amounts) (Tricare/CHAMPUS Policy Manual)
                                8. PDF FilePOL Chap 13 Sect 6.1H -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Adjustments To Payment Amounts) (Tricare/CHAMPUS Policy Manual)
                                9. PDF FilePOL Chap 13 Sect 6.1I -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Information Provided By TMA) (Tricare/CHAMPUS Policy Manual)
                                10. PDF FilePOL Chap 13 Sect 6.1J -- Hospital Reimbursement - TRICARE/CHAMPUS DRG-Based Payment System (Charges To Beneficiaries) (Tricare/CHAMPUS Policy Manual)
                                11. PDF FilePOL Chap 13 Sect 6.2 -- Hospital Reimbursement - Billed Charges Set Rates (Tricare/CHAMPUS Policy Manual)
                                12. PDF FilePOL Chap 13 Sect 6.3 -- Hospital Reimbursement - Other Than Billed Charges (Tricare/CHAMPUS Policy Manual)
                                13. PDF FilePOL Chap 13 Sect 6.4 -- Hospital Reimbursement - Payment When Only SNF Level Of Care Is Required (Tricare/CHAMPUS Policy Manual)
                                14. PDF FilePOL Chap 13 Sect 6.5 -- Hospital Reimbursement - TRICARE/CHAMPUS Inpatient Mental Health Per Diem Payment System (Tricare/CHAMPUS Policy Manual)
                                15. PDF FilePOL Chap 13 Sect 6.7 -- Psychiatric Partial Hospitalization Program Reimbursement (Tricare/CHAMPUS Policy Manual)
                                16. PDF FilePOL Chap 13 Sect 6.8 -- Substance Use Disorder Rehabilitation Facilities Reimbursement (Tricare/CHAMPUS Policy Manual)
                                17. PDF FilePOL Chap 13 Sect 6.9 -- Hospital Reimbursement - Outpatient Services (Tricare/CHAMPUS Policy Manual)
                                18. PDF FilePOL Chap 13 Sect 7.1 -- Skilled Nursing Facility (SNF) Reimbursement (Tricare/CHAMPUS Policy Manual)
                                19. PDF FilePOL Chap 13 Sect 8.1 -- Residential Treatment Center (RTC) Reimbursement (Tricare/CHAMPUS Policy Manual)
                                20. Expand to show POL Chap 13 Sect 9.1 contentsPDF FilePOL Chap 13 Sect 9.1 -- Ambulatory Surgical Center Reimbursement (Tricare/CHAMPUS Policy Manual)
                                  1. PDF FilePOL Chap 13 Sect 10.1 -- Preferred Provider Organization (PPO) Reimbursement (Tricare/CHAMPUS Policy Manual)
                                  2. Expand to show POL Chap 13 Sect 11.1 contentsPDF FilePOL Chap 13 Sect 11.1 -- Cost-Shares And Deductibles (Tricare/CHAMPUS Policy Manual)
                                    1. PDF FilePOL Chap 13 Sect 12.1 -- Double Coverage (Tricare/CHAMPUS Policy Manual)
                                    2. PDF FilePOL Chap 13 Sect 14.1 -- Catastrophic Loss Protection (Tricare/CHAMPUS Policy Manual)
                                    3. Collapse to hide POL Chap 13 Sect 16.1 contentsPDF FilePOL Chap 13 Sect 16.1 -- Waiver Of Liability (Tricare/CHAMPUS Policy Manual)
                                      1. PDF FilePOL Chap 13 Sect 16.1 Addendum 1 -- Waiver Of Liability - Initial Denial Determinations (Tricare/CHAMPUS Policy Manual)
                                      2. PDF FilePOL Chap 13 Sect 16.1 Addendum 2 -- Waiver Of Liability - MCS Contractor Reconsideration Determinations (Tricare/CHAMPUS Policy Manual)
                                      3. PDF FilePOL Chap 13 Sect 16.1 Addendum 3 -- Waiver Of Liability - NQMC Reconsideration Determinations (Tricare/CHAMPUS Policy Manual)
                                    4. PDF FilePOL Chap 13 Sect 18.1 -- Accommodation Of Discounts Under Provider Reimbursement Methods (Tricare/CHAMPUS Policy Manual)
                                    5. PDF FilePOL Chap 13 Sect 20.1 -- Legal Obligation To Pay (Tricare/CHAMPUS Policy Manual)
                                    6. PDF FilePOL Chap 13 Sect 22.1A -- Hospice Reimbursement - General Overview (Tricare/CHAMPUS Policy Manual)
                                    7. PDF FilePOL Chap 13 Sect 22.1B -- Hospice Reimbursement - Coverage/Benefits (Tricare/CHAMPUS Policy Manual)
                                    8. PDF FilePOL Chap 13 Sect 22.1C -- Hospice Reimbursement - Conditions For Coverage (Tricare/CHAMPUS Policy Manual)
                                    9. PDF FilePOL Chap 13 Sect 22.1D -- Hospice Reimbursement - Guidelines For Payment Of Designated Levels Of Care (Tricare/CHAMPUS Policy Manual)
                                    10. PDF FilePOL Chap 13 Sect 24.1 -- Reduction Of Payment For Noncompliance With Utilization Review Requirements (Tricare/CHAMPUS Policy Manual)
                                    11. PDF FilePOL Chap 13 Sect 25.1 -- Supplemental Insurance (Tricare/CHAMPUS Policy Manual)
                                    12. PDF FilePOL Chap 13 Sect 26.1 -- Point Of Service Option (Tricare/CHAMPUS Policy Manual)
                                    13. PDF FilePOL Chap 13 Sect 27.1 -- Reimbursement Of Emergency Inpatient Admissions To Unauthorized Facilities (Tricare/CHAMPUS Policy Manual)
                                    14. Expand to show POL Chap 13 Addendum 1 contentsPDF FilePOL Chap 13 Addendum 1 -- Health Benefit Program Agreement (Tricare/CHAMPUS Policy Manual)
                                      1. PDF FilePOL Chap 13 Addendum 7 -- Guidelines For The Calculation Of Individual Residential Treatment Center (RTC) Per Diem Rates (Tricare/CHAMPUS Policy Manual)
                                    15. PDF FilePOL Appendix A TOC -- TRICARE-Authorized Residential Treatment Centers - For Payment Of Services Provided On Or After 10/01/96 (TRICARE/CHAMPUS Policy Manual)
                                    16. PDF FilePOL Appendix A-1 -- TRICARE-Authorized Residential Treatment Centers - For Payment Of Services Provided On Or After 10/01/96 (TRICARE/CHAMPUS Policy Manual)
                                    17. PDF FilePOL Appendix A-2 -- TRICARE-Authorized Residential Treatment Centers - For Payment Of Services Provided On Or After 10/01/97 (TRICARE/CHAMPUS Policy Manual)
                                    18. PDF FilePOL Appendix A-3 -- TRICARE-Authorized Residential Treatment Centers - For Payment Of Services Provided On Or After 10/01/98 (TRICARE/CHAMPUS Policy Manual)
                                    19. PDF FilePOL Appendix B TOC (TRICARE/CHAMPUS Policy Manual)
                                    20. PDF FilePOL Appendix B -- TRICARE/CHAMPUS Standards For Residential Treatment Centers Serving Children And Adolescents (RTCs) (Tricare/CHAMPUS Policy Manual)
                                    21. PDF FilePOL Index (TRICARE/CHAMPUS Policy Manual)