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Outpatient Prospective Payment System

TRICARE's Outpatient Prospective Payment System (OPPS) was implemented on May 1, 2009.

Note: To minimize download times, some of these documents are being supplied in zip format as well as unzipped. You must have file compression software on your computer in order to take advantage of the zipped format.

Payment Status by HCPCS Code

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Ambulatory Payment Classifications (APCs) with Status Indicators (SIs) and Payment Rates

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Payment Status Indicators

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Payment Status by HCPCS Code - Drugs

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Annual Updates

Maternity Diagnosis

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OPPS Pricing Elements

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Statewide Cost to Charge Ratios

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Therapy Codes

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Provider Information Updates

OPPS Provider File

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Provider Types contained in the OPPS provider file:

  • 00 = Short Term Facility
  • 02 = Long Term
  • 03 = Psychiatric
  • 04 = Rehabilitation Facility
  • 06 = Hospital Distinct Parts
  • 07 = Rural Referral Center
  • 14 = Medicare Dependent Hospital
  • 15 = Medicare Dependent Hospital/Referral Center
  • 16 = Sole Community Hospital
  • 17 = Sole Community Hospital/Referral Center
  • 21 = Essential Access Hospital
  • 22 = Essential Access Hospital/Referral Center
  • 47 = Community Mental Health Centers
  • 49 = Psychiatric Distinct Part
  • 50 = Rehabilitation Distinct Part

Provider Types (download)

ZIP to Wage Index Crosswalk

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Quarterly Updates

Last Updated: November 02, 2022
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