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TRICARE's Outpatient Prospective Payment System was implemented on May 1, 2009.
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The age/sex lists represent codes that TRICARE recognizes as having age and or sex restrictions. The TRICARE contractors need to make sure their age and sex file matches what is on the list or it could result in TRICARE Encounter Data Records failing.
The age restriction list is intended to serve as a factor of consideration in the processing of TRICARE beneficiary claims. While it provides valuable information to inform decision-making, it should be considered in conjunction with standard of care, healthcare delivery guidelines, and other relevant factors and not solely relied upon as the basis of approving or denying claims.
DHA/TRICARE no longer maintains sex restrictions as of April 1, 2024.
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Last Updated: April 08, 2025