TRICARE Reimbursement Methodologies

Reimbursement rates and methodologies are subject to change per Department of Defense (DoD) guidelines.

See the TRICARE Reimbursement Manual for more information.

Payments made to network providers for medical services to TRICARE beneficiaries shall not exceed 100 percent of the TRICARE-allowable charges.

This chapter outlines:

• CHAMPUS and TRICARE Allowed Charges
• Anesthesia Claims and Reimbursement
• Ambulatory Surgery Grouper Rates
• Diagnosis-Related Group Reimbursement
• Bonus Payments in Health Professional Shortage Areas
• Pricing
• Surgical Services
• Hospice Pricing
• Outpatient Prospective Payment System
• Pricing Updates