CHAMPUS maximum allowable charge (CMAC) information can be accessed directly from your Web browser through the CMAC National Pricing System. No special software is required. You can easily retrieve pricing and prevailing fees for a particular procedure code within a selected locality.
 

1. Visit the Champus National Pricing System Web site. 
   Accept the “End User Point and Click Agreement.”
2. Submit your query.

Be sure to note the “Web Posting Date” on each page, which indicates the date when the information was last updated. 

The site also offers CMAC cross-reference utilities. The chart below highlights the features you can use by clicking on CMAC Cross Reference Utilities.

Be sure to note that each year the Department of Defense (DoD) updates the CMAC National Pricing system. The diagnosis-related group (DRG) rates are usually adjusted in October, while CMAC Procedural Pricing updates occur in early spring. If you are looking for reimbursement rates for the Healthcare Common Procedure Coding System (HCPCS), this information is available on the PGBA Web site.

Questions and comments about the TRICARE CMAC site can be sent to Webmaster-CMAC@tma.osd.mil.

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NEW Fee Schedule Pricing for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (Article 14)

As of September 1, 2005, the implementation of the new durable medical equipment prosthetics, orthotics and supplies (DMEPOS) fee schedule went into effect.

The policy indicates a revised definition of durable medical equipment (DME) and adopts the same pricing methods for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The new fee schedule replaces the existing state prevailing pricing for codes available on the DMEPOS schedule.

DMEPOS prices are established by using fee schedules, reasonable charges or average wholesale pricing. Most payments of DME are based on a fee schedule established for each DMEPOS item by state. The services and/or supplies are coded using HCPC Level II codes that begin with the letters A (medical and surgical supplies), B (enteral and parenteral therapy), E (durable medical equipment), K (temporary codes), L (orthotics and prosthetic procedures) and V (vision services).

Inclusion or exclusion of a fee schedule amount for an item or service does not imply any TRICARE coverage.

In addition to the DMEPOS schedule, Parenteral and Enteral Nutrition Items and Services (PEN) and fees are also included. DMEPOS pricing information is available at the CMS Web site.

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