Updates to TRICARE Rates and Weights
Reimbursement rates and methodologies are subject to change per DoD guidelines. TRICARE rates are subject to change on at least an annual basis. Rate changes are usually effective on the dates listed in Figure 9.4. Figure 9.4 TRICARE Rates Updates Schedule
Update Frequency
|
Rates Scheduled to Change
|
Variable at TMA's discretion
|
- CHAMPUS maximum allowable charge (CMAC) (may be adjusted quarterly)
- Anesthesia
- Injectables and immunizations
|
April 1
|
Birthing Centers |
October 1
|
- Diagnosis-related group
- Residential treatment center
- Mental health per diem
- Skilled nursing facility prospective payment system (may be adjusted quarterly)
- Inpatient hospital copayments and cost-shares
- Hospice
|
November 1
|
Ambulatory surgery grouper |
December 1
|
Critical access hospital |
Quarterly (January, April, July, October)
|
- Durable medical equipment, prosthetics, orthotics, and supplies
- Home health prospective payment system
- Outpatient prospective payment system
|
The DoD has adjusted the TRICARE Reimbursement rates to mirror Medicare’s levels.
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