MHS UBO Rates

These files contain all localities and are compressed in a .zip file format. Please download the entire file before attempting to open.

CMAC Rates are adjusted for the locality of the providing military treatment facility (MTF). The following tables provide the key to determining which CMAC locality is appropriate for each MTF.

For CSE access, please contact your UBO Service Program Manager. A provider version is available upon request. Providers must email the UBO Help Desk to receive access credentials.

The DoD inpatient rates are approved and posted on the DoD Comptroller website. These rates are used when billing for inpatient medical services at MTFs.

A national number used to determine if a patient has exceeded the length of stay (LOS) threshold for the Diagnosis Related Group (DRG) assigned to the inpatient stay. When the LOS exceeds the threshold, additional charges apply. 

• Calculation to determine additional charges per day: PDW x .33 x MTF Adjusted Standardized Amounts (ASA)
• Calculation Per Diem Weight (PDW): DRG Relative Weighted Product (RWP)/Geometric Mean LOS
• Calculation for total billed amount: (DRG RWP x MTF ASA) + (PDW x .33 x #days in excess of LST x MTF ASA)

Pharmacy rates are derived from the Managed Care Pricing File (MCPF) supplied by the Defense Supply Center and are based on TRICARE allowable charges, Average Wholesale Price (AWP), or Prime Vendor Program (PVP) prices listed for the National Drug Codes (NDC).

Rates are established on a unit measure price basis, and are standardized for NDCs within each generic sequence number (GSN). A GSN groups a set of NDCs with the same active ingredients, dosage form, and strength, regardless of vendor brand or generic description. Currently, rates are computed based on the median unit measure cost for all of the AWP listed NDCs in each GSN group. The mediun unit measure price is applied to all the NDCs in each GSN group. 

Where there are no AWP listed NDCs in a GSN group, the rate for the NDCs is set to the median unit measure price of the PVP listed for the NDCs in that GSN group. As of January 2010, unit measure prices reflect the median TRICARE allowable ingredient costs. 

• For the most accurate information on whether a specific drug requires prior authorization, please use the Formulary Search Tool.
• Before submitting claims to other health insurance carriers, MTFs should review the insurance carrier's website for its current list of pharmaceuticals requiring prior authorization. 

The billing rates below are for services provided at DoD deployed/non-fixed facilities to foreign nationals covered under Acquisition and Cross-Servicing Agreements (ACSA) and for services for patients other than foreign military personnel covered under ASCA.