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Outpatient Prospective Payment System

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

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Quarterly Updates

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

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Payment Status by HCPCS Code

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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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DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

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