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Effective Oct. 1, 2023, the Defense Health Agency has adopted Medicare's payment system for the Reimbursement of Ambulatory Surgery Centers. The rates on this page apply to services rendered before this date. For more information, visit the TRICARE Reimbursement Manual, Chapter 9, reference the final rule at 88 FR 19844 or contact your managed care support contractor.
Generating APC Reimbursement Rates
To generate an APC reimbursement rate, please follow these steps:
- Use the Crosswalk of ZIP Code to MSA Code file to determine the MSA code for the subject ZIP Code.
- Use the ASC Payment Group Assignment file (from the ASCGR dropdown menu below) to determine the ASC Group for the subject CPT Code.
- Use the ASC Payment Group Rates by MSA file (from the ASCRT dropdown menu below) to determine the rate for the MSA Code from step 1 and the ASC Payment Group from step 2.
TRICARE-Approved Procedures for Freestanding Ambulatory Surgery Centers
- Effective Nov. 1, 2016 to Feb. 28, 2017.
- Note: This file is no longer updated; for historical purposes only.
MSA Name
Lines with termination date of "99999999" will always be the current rate.
Correction Date 00000000 means not applicable.
All variables right-adjusted.
Crosswalk of ZIP Code to MSA Code
Listed for each procedure code as a cumulative history file and sorted by CPT code.
The effective and termination dates refer to application of the group assignment.
Any multiple lines for a CPT code due to group changes will be in date order, oldest first.
Lines with termination date of "99999999" will always be the current group.
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Last Updated: September 25, 2023