Only non-OPPS providers are reimbursed under this methodology. Effective May 1, 2009, hospital-based surgery procedures are reimbursed under OPPS.

Ambulatory surgery facility payments fall into one of 11 TRICARE grouper rates. All procedures identified by the TMA for reimbursement under this methodology can be found in TRICARE's Reimbursement Manual. TRICARE payment rates established under this system apply only to the facility charges for ambulatory surgery.

Ambulatory surgery providers may view reimbursements, ambulatory surgery rates, and grouper assignments by visiting TRICARE's Ambulatory Surgery Rates web page.
      

Effective April 1, 2008, all hospitals or freestanding ambulatory surgery centers (ASCs) must submit claims for surgery procedures on a UB-04 claim form. Hospital-based ASC providers must use Type of Bill (TOB) 13X.

Ambulatory surgery providers may view reimbursements and grouper assignments at TRICARE's Ambulatory Surgery Rates web page, or they may contact their local Humana Military provider relations representative.