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 Office of Management and Budget
 By virtue of the authority vested in the President by Section 2(a) of Public Law 87-693 (76 Stat. 593; 42 U.S.C. 2652), and delegated to the Director of the Office of Management and Budget by Executive Order No. 11541 of July 1, 1970 (35 FR 10737), the three sets of rates outlined below are hereby established. These rates are for use in connection with the recovery, from tortiously liable third persons, of the cost of hospital and medical care and treatment furnished by the United States (Part 43, Chapter I, Title 28, Code of Federal Regulations) through three separate Federal agencies. The rates have been established in accordance with the requirements of OMB Circular A-25, requiring reimbursement of the full cost of all services provided. The rates are established as follows: 1. Department of Defense The FY 2001 Department of Defense (DoD) reimbursement rates for inpatient, outpatient, and other services are provided in accordance with Title 10, United States Code, section 1095. Due to size, the sections containing the Drug Reimbursement Rates (section IV.C.) and the rates for Ancillary Services Requested by Outside Providers (section IV.D.) are not included in this package. Those rates are available from the TRICARE Management Activity's Uniform Business Office website, 
                    *http://www.tricare.osd.mil/​ebc/​rm/​rm_​home.html.*
                     The medical and dental service rates in this package (including the rates for ancillary services and other procedures requested by outside providers) are effective October 1, 2000. Pharmacy rates are updated on an as needed basis. 2. Health and Human Services The FY 2001 tortiously liable rates for Indian Health Service health facilities are based on Medicare cost reports. The obligations for the Indian Health Service hospitals participating in the cost report 
                    ( print page 65025)
                    project were identified and combined with applicable obligations for area offices costs and headquarters costs. The hospital obligations were summarized for each major cost center providing medical services and distributed between inpatient and outpatient. Total inpatient costs and outpatient costs were then divided by the relevant workload statistic (inpatient day, outpatient visit) to produce the inpatient and outpatient rates. In calculation of the rates, the Department's unfunded retirement liability cost and capital and equipment depreciation costs were incorporated to conform to requirements set forth in OMB Circular A-25. In addition, the obligations for each cost center include obligations from certain other accounts, such as Medicare and Medicaid collections and the Contract Health fund, that were used to support the inpatient and outpatient workload. Obligations were excluded for certain cost centers that primarily support workloads outside of the directly operated hospitals or clinics (public health nursing, public health nutrition, health education). These obligations are not a part of the traditional cost of hospital operations and do not contribute directly to the inpatient and outpatient visit workload. Separate rates per inpatient day and outpatient visit were computed for Alaska and the rest of the United States. This gives proper weight to the higher cost of operating medical facilities in Alaska. 1. Department of Defense For the Department of Defense, effective October 1, 2000 and thereafter: Inpatient, Outpatient and Other Rates and Charges 1. Inpatient Rates12 Per inpatient day
International Military Education and Training (IMET)
Interagency and other Federal agency sponsored patients
Other 
                             (full/third party)A. Burn Center
$4,144.00
$5,694.00
$6,016.00B. Surgical Care Services (Cosmetic Surgery)
1,895.00
2,604.00
2,752.00C. All Other Inpatient Services (Based on Diagnosis Related Groups (DRG) 3
 Average FY01 Direct Care Inpatient Reimbursement Rates Adjusted standard amount
IMET
Interagency
Other 
                             (full/third party)Large Urban
$2,986.00
$5,712.00
$6,002.00Other Urban/Rural
3,468.00
6,633.00
7,004.00Overseas
3,872.00
9,045.00
9,489.00
 2. Overview The FY01 inpatient rates are based on the cost per DRG, which is the inpatient full reimbursement rate per hospital discharge weighted to reflect the intensity of the principal diagnosis, secondary diagnoses, procedures, patient age, etc. involved. The average cost per Relative Weighted Product (RWP) for large urban, other urban/rural, and overseas facilities will be published annually as an inpatient adjusted standardized amount (ASA) (see paragraph I.C.1., above). The ASA will be applied to the RWP for each inpatient case, determined from the DRG weights, outlier thresholds, and payment rules published annually for hospital reimbursement rates under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) pursuant to 32 CFR 199.14(a)(1), including adjustments for length of stay (LOS) outliers. Each large urban or other urban/rural MTF providing inpatient care has their own ASA rate—The MTF-specific ASA rate is the published ASA rate adjusted for area wage differences and indirect medical education (IME) for the discharging hospital (see Attachment 1). The MTF-specific ASA rate submitted on the claim is the rate that payers will use for reimbursement purposes. For a more complete description of the development of MTF-ASAs and how they are applied refer to the ASA Primer at 
                    *http://www.tricare.osd.mil/​org/​pae/​asaprimer/​asaprimer1.html.* Overseas MTFs use the rates specified in paragraph I. C. 1. For providers performing inpatient care at a civilian facility for a DoD beneficiary, see note 3. An example of how to apply DoD costs to a DRG standardized weight to arrive at DoD costs is contained in paragraph I.C.3., below. 3. Example of Adjusted Standardized Amounts for Inpatient Stays Figure 1 shows examples for a non-teaching hospital (Reynolds Army Community Hospital) in an Other Urban/Rural area. a. The cost to be recovered is the military treatment facility's cost for medical services provided. Billings will be at the third party rate. b. DRG 020: Nervous System Infection Except Viral Meningitis. The RWP for an inlier case is the CHAMPUS weight of 2.2244. (DRG statistics shown are from FY 1999.) c. The MTF-applied ASA rate is $6,831 (Reynolds Army Community Hospital's third party rate as shown in Attachment 1). d. The MTF cost to be recovered is the RWP factor (2.2244) in subparagraph 3.b., above, multiplied by the amount ($6,831) in subparagraph 3.c., above. e. Cost to be recovered is $15,195. 
                    ( print page 65026) **Figure 1.—Third Party Billing Examples**
DRG number
DRG description
DRG weight
Arithmetic mean LOS
Geometric mean LOS
Short stay threshold
Long stay threshold020
Nervous System Infection Except Viral Meningitis
2.2244
8.3
5.8
1
29
 Hospital
Location
Area wage rate index
IME 
                             adjustment
Group ASA
MTF-applied ASAReynolds Army Community Hospital
Other urban/rural
.9156
1.0
$7,004
$6,831
 Patient
Length of stay (days)
Days above threshold
Relative weighted product
TPC Amount***Inlier*
Outlier**
Total#1
7
0
2.2244
000
2.2244
$15,195#2
21
0
2.2244
000
2.2244
$15,195#3
35
6
2.2244
.7594
2.9838
$20,382*
                         DRG Weight**
                         Outlier calculation = 33 percent of per diem weight × number of outlier days= .33 (DRG Weight/Geometric Mean LOS) × (Patient LOS—Long Stay Threshold)= .33 (2.2244/5.8) × (35-29)= .33 (.38352) × 6 (take out to five decimal places)= .12656 × 6 (carry to five decimal places)= .7594 (carry to four decimal places)***
                         MTF-Applied ASA × Total RWP
 **II. Outpatient Rates**
[Per Visit1,2]
MEPRS code 4
Clinical service
International military education and training (IMET)
Interagency and other federal agency sponsored patients
Other 
                             (full/third party)A. Medical Care:BAA
Internal Medicine
$147.00
$204.00
$216.00BAB
Allergy
80.00
111.00
117.00BAC
Cardiology
129.00
180.00
190.00BAE
Diabetic
105.00
146.00
154.00BAF
Endocrinology (Metabolism)
151.00
210.00
222.00BAG
Gastroenterology
183.00
255.00
269.00BAH
Hematology
286.00
398.00
420.00BAI
Hypertension
216.00
301.00
318.00BAJ
Nephrology
221.00
307.00
324.00BAK
Neurology
165.00
229.00
242.00BAL
Outpatient Nutrition
69.00
96.00
101.00BAM
Oncology
201.00
280.00
295.00BAN
Pulmonary Disease
186.00
259.00
273.00BAO
Rheumatology
139.00
194.00
205.00BAP
Dermatology
115.00
160.00
169.00BAQ
Infectious Disease
181.00
252.00
266.00BAR
Physical Medicine
115.00
160.00
169.00BAS
Radiation Therapy
169.00
235.00
248.00BAT
Bone Marrow Transplant
190.00
264.00
279.00BAU
Genetic
330.00
460.00
485.00BAV
Hyperbaric
344.00
480.00
506.00B. Surgical Care:BBA
General Surgery
215.00
299.00
316.00BBB
Cardiovascular and Thoracic Surgery
419.00
584.00
616.00BBC
Neurosurgery
249.00
347.00
366.00BBD
Ophthalmology
130.00
181.00
191.00BBE
Organ Transplant
1,106.00
1,541.00
1,625.00BBF
Otolaryngology
149.00
207.00
219.00BBG
Plastic Surgery
168.00
235.00
247.00BBH
Proctology
125.00
174.00
184.00BBI
Urology
164.00
228.00
240.00BBJ
Pediatric Surgery
89.00
125.00
131.00BBK
Peripheral Vascular Surgery
98.00
137.00
145.00BBL
Pain Management
138.00
193.00
203.00BBM
Vascular and Interventional Radiology
493.00
687.00
724.00C. Obstetrical and Gynecological (OB-GYN) Care:BCA
Family Planning
76.00
106.00
111.00( print page 65027)BCB
Gynecology
127.00
177.00
187.00BCC
Obstetrics
104.00
144.00
152.00BCD
Breast Cancer Clinic
240.00
334.00
352.00D. Pediatric Care:BDA
Pediatric
92.00
128.00
134.00BDB
Adolescent
83.00
115.00
121.00BDC
Well Baby
63.00
87.00
92.00E. Orthopaedic Care:BEA
Orthopaedic
143.00
200.00
211.00BEB
Cast
89.00
123.00
130.00BEC
Hand Surgery
76.00
106.00
112.00BEE
Orthotic Laboratory
93.00
130.00
137.00BEF
Podiatry
80.00
112.00
118.00BEZ
Chiropractic
38.00
53.00
55.00F. Psychiatric and/or Mental Health Care:BFA
Psychiatry
165.00
230.00
242.00BFB
Psychology
115.00
160.00
169.00BFC
Child Guidance
92.00
128.00
135.00BFD
Mental Health
148.00
206.00
217.00BFE
Social Work
147.00
205.00
217.00BFF
Substance Abuse
141.00
197.00
208.00G. Family Practice/Primary Medical Care:BGA
Family Practice
107.00
149.00
157.00BHA
Primary Care
109.00
151.00
160.00BHB
Medical Examination
111.00
155.00
163.00BHC
Optometry
72.00
100.00
105.00BHD
Audiology
52.00
73.00
77.00BHE
Speech Pathology
122.00
170.00
180.00BHF
Community Health
85.00
118.00
125.00BHG
Occupational Health
108.00
151.00
159.00BHH
TRICARE Outpatient
74.00
104.00
109.00BHI
Immediate Care
161.00
225.00
237.00H. Emergency Medical Care:BIA
Emergency Medical
173.00
242.00
255.00I. Flight Medical Care:BJA
Flight Medicine
124.00
173.00
182.00J. Underseas Medical Care:BKA
Underseas Medicine
77.00
108.00
114.00K. Rehabilitative Services:BLA
Physical Therapy
56.00
79.00
83.00BLB
Occupational Therapy
75.00
104.00
110.00
 III. Ambulatory Procedure Visit (APV)
[Per visit 5
                        ]
MEPRS code 4
Clinical service
International military education and training (IMET)
Interagency and other federal agency sponsored patients
Other 
                             (full/third party)Medical Care:BB
Surgical Care
$1,313.00
$1,829.00
$1,929.00BE
Orthopaedic Care
1,664.00
2,319.00
2,446.00All Other
B clinics other than BB and BE, to include those B clinics where:
378.00
527.00
556.001. There is an APU established within DoD guidelines AND—2. There is a rate established for that clinic in section II. Some B clinics, such as BF, BI, BJ and BL, perform the type of services where the establishment of an APU would not be within appropriate clinical guidelines.
 
 
 IV. Other Rates and Charges 1
                         2
MEPRS code 4
Clinical service
International military education and training (IMET)
Interagency and other federal agency sponsored patients
Other 
                             (full/third party)A. Per Each:FBI
Immunization
$22.00
$31.00
$32.00B. Family Member Rate: $11.45 (formerly Military Dependents Rate)C. Reimbursement Rates For Drugs Requested By Outside Providers: 6
                             \15\D. Ancillary Services Requested by an Outside Provider—Per Procedure: 7
                             15DB
Laboratory procedures requested by an outside provider CPT '00 Weight Multiplier
15.00
22.00
23.00DC, DI
Radiology procedures requested by an outside provider CPT '00 Weight Multiplier
79.00
115.00
120.00E. Dental Rate—Per Procedure: 11Dental Services ADA code weight multiplier
73.00
112.00
117.00F. Ambulance Rate—Per Hour: 12FEA
Ambulance
81.00
113.00
120.00G. AirEvac Rate—Per Trip (24 hour period): 13AirEvac Services—Ambulatory
339.00
473.00
499.00AirEvac Services—Litter
989.00
1,379.00
1,454.00H. Observation Rate—Per hour—14Observation Services—Hour
20.00
28.00
30.00
 **V. Elective Cosmetic Surgery Procedures and Rates**
Cosmetic surgery procedure
International classification diseases 
                             (ICD-9)
Current procedural terminology (CPT) 8
FY 2001 Charge 9
Amount of chargeMammaplasty—augmentation
85.50
19325
Inpatient Surgical Care Per Diem or APV
(a) 
                             
                                (b)85.32
1932485.31
19318Mastopexy
85.60
19316
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)Facial
86.82
15824
Inpatient Surgical Care Per Diem or APV
(a) 
                             
                                (b)Rhytidectomy
86.22Blepharoplasty
08.70
15820
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)08.44
158211582215823Mentoplasty (Augmentation/or Reduction)
76.68
21208
Inpatient Surgical Care Per Diem APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)76.67
21209Abdominoplasty
86.83
15831
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)Lipectomy
86.83
15876
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)Suction per region 10

158771587815879Rhinoplasty
21.87
30400
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)21.86
30410( print page 65029)Scar Revisions beyond CHAMPUS
86.84
1578_
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)Mandibular or Maxillary Repositioning
76.41
21194
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)Dermabrasion
86.25
15780
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)Hair Restoration
86.64
15775
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)Removing Tattoos
86.25
15780
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)Chemical Peel
86.24
15790
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)Arm/Thigh: Dermolipectomy
86.83
15836/
Inpatient Surgical Care Per Diem or APV APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (b) 
                             
                             
                                (c) 
                             
                             
                                (e)Refractive surgery

15832Radial Keratotomy

65771Other Procedure (if applies to laser or other 
                             refractive surgery)

66999Otoplasty

69300
APV or applicable Outpatient Clinic Rate
(b) 
                             
                                (c)Brow Lift
86.3
15839
Inpatient Surgical Care Per Diem or APV or applicable Outpatient Clinic Rate
(a) 
                             
                                (b) 
                             
                             
                                (c)
 Notes on Cosmetic Surgery Charges a
                         Per diem charges for inpatient surgical care services are listed in section I.B. (See notes 8 through 10, below, for further details on reimbursable rates.) b
                         Charges for ambulatory procedure visits (formerly same day surgery) are listed in section III. (See notes 8 through 10, below, for further details on reimbursable rates.) The ambulatory procedure visit (APV) rate is used if the elective cosmetic surgery is performed in an ambulatory procedure unit (APU). c
                         Charges for outpatient clinic visits are listed in sections II.A-K. The outpatient clinic rate is not used for services provided in an APU. The APV rate should be used in these cases. d
                         Charge is solely determined by the location of where the care is provided and is not to be based on any other criteria. An APV rate can only be billed if the location has been established as an APU following all required DoD guidelines and instructions. e
                         Refer to HA Policy on Vision Correction Via Laser Surgery For Non-Active Duty Beneficiaries, April 7, 2000 for further guidance on billing for these services. It can be downloaded from 
                        *http://www.tricare.osd.mil/​policy/​2000poli.htm.* Notes on Reimbursable Rates 1
                         Percentages can be applied when preparing bills for both inpatient and outpatient services. Pursuant to the provisions of 10 U.S.C. 1095, the inpatient Diagnosis Related Groups and inpatient per diem percentages are 98 percent hospital and 2 percent professional charges. The outpatient per visit percentages are 89 percent outpatient services and 11 percent professional charges. 2
                         DoD civilian employees located in overseas areas shall be rendered a bill when services are performed. 3
                         The cost per Diagnosis Related Group (DRG) is based on the inpatient full reimbursement rate per hospital discharge, weighted to reflect the intensity of the principal and secondary diagnoses, surgical procedures, and patient demographics involved. The adjusted standardized amounts (ASA) per Relative Weighted Product (RWP) for use in the direct care system is comparable to procedures used by the Health Care Financing Administration (HCFA) and the Civilian Health and Medical Program for the Uniformed Services (CHAMPUS). These expenses include all direct care expenses associated with direct patient care. The average cost per RWP for large urban, other urban/rural, and overseas will be published annually as an adjusted standardized amount (ASA) and will include the cost of inpatient professional services. The DRG rates will apply to reimbursement from all sources, not just third party payers. MTFs without inpatient services, whose providers are performing inpatient care in a civilian facility for a DoD beneficiary, can bill payers the percentage of the charge that represents professional services as provided in1
                         above. The ASA rate used in these cases, based on the absence of a ASA rate for the facility, will be based on the average ASA rate for the type of metropolitan statistical area the MTF resides, large urban, other urban/rural, or overseas. (see paragraph I.C.1.). The Uniform Business Office must receive documentation of care provided in order to produce a bill. 4
                         The Medical Expense and Performance Reporting System (MEPRS) code is a three 
                        ( print page 65030)
                        digit code which defines the summary account and the sub account within a functional category in the DoD medical system. MEPRS codes are used to ensure that consistent expense and operating performance data is reported in the DoD military medical system. An example of the MEPRS hierarchical arrangement follows: MEPRS CodeOutpatient Care (Functional Category)
B.Medical Care (Summary Account)
BA.Internal Medicine (Subaccount)
BAA.
 5
                         Ambulatory procedure visit is defined in DoD Instruction 6025.8, “Ambulatory Procedure Visit (APV),” dated September 23, 1996, as immediate (day of procedure) pre-procedure and immediate post-procedure care requiring an unusual degree of intensity and provided in an ambulatory procedure unit (APU). An APU is a location or organization within an MTF (or freestanding outpatient clinic) that is specially equipped, staffed, and designated for the purpose of providing the intensive level of care associated with APVs. Care is required in the facility for less than 24 hours. All expenses and workload are assigned to the MTF-established APU associated with the referring clinic. The BB and BE APV rates are to be used only by clinics that are subaccounts under these summary accounts (see4
                         for an explanation of MEPRS hierarchical arrangement). The All Other APV rate is to be used only by those clinics that are not a subaccount under BB or BE. In addition, APV rates may only be utilized for clinics where there is a clinic rate established. For example, BLC, Neuromuscular Screening, no longer has an established rate. Therefore, an APU can not be defined and an APV can not be billed for this clinic. 6
                         Third party payers (such as insurance companies) shall be billed for prescription services when beneficiaries who have medical insurance obtain medications from a Military Treatment Facility (MTF) that are prescribed by providers external to the MTF (
                        *e.g.,*
                         physicians and dentists). Eligible beneficiaries (family members or retirees with medical insurance) are not liable personally for this cost and shall not be billed by the MTF. Medical Services Account (MSA) patients, who are not beneficiaries as defined in 10 U.S.C. 1074 and 1076, are charged at the “Other” rate if they are seen by an outside provider and only come to the MTF for prescription services. The standard cost of medications ordered by an outside provider includes the DoD-wide average cost of the drug, calculated by National Drug Code (NDC) number. The prescription charge is calculated by multiplying the number of units (
                        *e.g.,*
                         tablets or capsules) by the unit cost and adding $6.00 for the cost of dispensing the prescription. Dispensing costs include overhead, supplies and labor, etc. to fill the prescription. The list of drug reimbursement rates is too large to include in this document. Those rates are available from the TRICARE Management Activity's Uniform Business Office website, 
                        *http://www.tricare.osd.mil/​ebc/​rm/​rm_​home.html.* 7
                         The list of FY 2001 rates for ancillary services requested by outside providers and obtained at a Military Treatment Facility is too large to include in this document. Those rates are available from the TRICARE Management Activity's Uniform Business Office website, 
                        *http://www.tricare.osd.mil/​ebc/​rm/​rm_​home.html.* Charges for ancillary services requested by an outside provider (
                        *e.g.,*
                         physicians and dentists) are relevant to the Third Party Collection Program. Third party payers (such as insurance companies) shall be billed for ancillary services when beneficiaries who have medical insurance obtain services from the MTF which are prescribed by providers external to the MTF. Laboratory and Radiology procedure costs are calculated by multiplying the DoD established weight for the Physicians' Current Procedural Terminology (CPT 00) code by either the laboratory or radiology multiplier (section IV.D.). Radiology procedures performed by Nuclear Medicine use the same methodology as Radiology for calculating a charge because their workload and expenses are included in the establishment of the Radiology multiplier. Eligible beneficiaries (family members or retirees with medical insurance) are not personally liable for this cost and shall not be billed by the MTF. MSA patients, who are not beneficiaries as defined by 10 U.S.C. 1074 and 1076, are charged at the “Other” rate if they are seen by an outside provider and only come to the MTF for ancillary services. 8
                         The attending physician is to complete the CPT 00 code to indicate the appropriate procedure followed during cosmetic surgery. The appropriate rate will be applied depending on the treatment modality of the patient: ambulatory procedure visit, outpatient clinic visit or inpatient surgical care services. 9
                         Family members of active duty personnel, retirees and their family members, and survivors shall be charged elective cosmetic surgery rates. Elective cosmetic surgery procedure information is contained in section V. The patient shall be charged the rate as specified in the FY 2001 reimbursable rates for an episode of care. The charges for elective cosmetic surgery are at the full reimbursement rate (designated as the “Other” rate) for inpatient per diem surgical care services in section I.B., ambulatory procedure visits as contained in section III., or the appropriate outpatient clinic rate in sections II.A-K. The patient is responsible for the cost of the implant(s) and the prescribed cosmetic surgery rate. (Note: The implants and procedures used for the augmentation mammaplasty are in compliance with Federal Drug Administration guidelines.) 10
                         Each regional lipectomy shall carry a separate charge. Regions include head and neck, abdomen, flanks, and hips. 11
                         Dental service rates are based on a dental rate multiplied by the DoD established weight for the American Dental Association (ADA) code performed. For example, for ADA code 00270, bite wing single film, the weight is 0.15. The weight of 0.15 is multiplied by the appropriate rate, IMET, IAR, or Full/Third Party rate to obtain the charge. If the Full/Third Party rate is used, then the charge for this ADA code will be $17.55 ($117 × .15 = $17.55). The list of FY 2001 ADA codes and weights for dental services is too large to include in this document. Those rates are available from the TRICARE Management Activity's Uniform Business Office website, 
                        *http://www.tricare.osd.mil/​ebc/​rm/​rm_​home.html.* 12
                         Ambulance charges shall be based on hours of service in 15 minute increments. The rates listed in section IV.F. are for 60 minutes or 1 hour of service. Providers shall calculate the charges based on the number of hours (and/or fractions of an hour) that the ambulance is logged out on a patient run. Fractions of an hour shall be rounded to the next 15 minute increment (e.g., 31 minutes shall be charged as 45 minutes). 13
                         Air in-flight medical care reimbursement charges are determined by the status of the patient (ambulatory or litter) and are per patient during a 24 hour period. The appropriate charges are billed only by the Air Force Global Patient Movement Requirement Center (GPMRC). These charges are only for the cost of providing medical care. Flight charges are billed by GPMRC separately. 14
                         Observation Services are billed at the hourly charge. Begin counting when the patient is placed in the observation bed and round to the nearest hour. For example, if a patient has received one hour and 20 minutes of observation, then you bill for one hour of service. If the status of a patient changes to inpatient, the charges for observation services are added to the DRG assigned to the case and not separately billed. If a patient is released from observation status and is sent to an APV, the charges for observation services are not billed separately but are added to the APV rate to recover all expenses. 15
                         Final rule 32 CFR part 220, published February 16, 2000, eliminated the dollar threshold for high cost ancillary services and the associated term “high cost ancillary service.” The phrase “high cost ancillary service” is replaced with the phrase “ancillary services requested by an outside provider.” The elimination of the threshold also eliminated the need to bundle costs whereby a patient is billed if the total cost of ancillary services in a day (defined as 0001 hours to 2400 hours) exceeds $25.00. The elimination of the threshold is effective as per date stated in final rule 32 CFR Part 220. 
 
 **Attachment 1.—Adjusted Standardized Amounts (ASA) By Military Treatment Facility**
DMISID
MTF name
Serv
Full cost rate
Interagency rate
IMET rate
TPC rate0003
Lyster AH—Ft. Rucker
A
$6,637
$6,286
$3,286
$6,6370004
502nd Med Grp—Maxwell AFB
F
6,984
6,614
3,458
6,9840005
Bassett ACH—Ft. Wainwright
A
7,152
6,774
3,541
7,1520006
3rd Med Grp—Elmendorf AFB
F
7,041
6,668
3,486
7,0410009
56th Med Grp—Luke AFB
F
5,986
5,697
2,978
5,9860014
60th Med Grp—Travis AFB
F
9,912
9,387
4,907
9,9120018
30th Med Grp—Vandenberg AFB
F
7,035
6,663
3,483
7,0350019
95th Med Grp—Edwards AFB
F
7,004
6,633
3,468
7,0040024
NH Camp Pendleton
N
7,614
7,245
3,787
7,6140028
NH Lemoore
N
6,997
6,627
3,465
6,9970029
NH San Diego
N
9,744
9,273
4,847
9,7440030
NH Twenty Nine Palms
N
6,111
5,815
3,039
6,1110032
Evans ACH—Ft. Carson
A
6,946
6,578
3,439
6,9460033
10th Med Grp—USAF Academy
F
6,994
6,623
3,463
6,9940037
Walter Reed AMC— Washington DC
A
9,010
8,574
4,482
9,0100038
NH Pensacola
N
8,939
8,465
4,426
8,9390039
NH Jacksonville
N
7,537
7,173
3,749
7,5370042
96th Med Grp—Eglin AFB
F
8,309
7,869
4,114
8,3090043
325th Med Grp—Tyndall AFB
F
7,002
6,631
3,467
7,0020045
6th Med Grp—MacDill AFB
F
5,991
5,702
2,980
5,9910047
Eisenhower AMC—Ft. Gordon
A
8,550
8,098
4,233
8,5500048
Martin ACH—Ft. Benning
A
7,987
7,564
3,954
7,9870049
Winn ACH—Ft. Stewart
A
6,644
6,292
3,289
6,6440052
Tripler AMC—Ft. Shafter
A
9,533
9,029
4,720
9,5330053
366th Med Grp—Mountain Home AFB
F
6,982
6,612
3,457
6,9820055
375th Med Grp—Scott AFB
F
7,625
7,256
3,793
7,6250056
NH Great Lakes
N
6,063
5,770
3,016
6,0630057
Irwin AH—Ft. Riley
A
6,521
6,176
3,229
6,5210060
Blanchfield ACH—Ft. Campbell
A
6,605
6,255
3,270
6,6050061
Ireland ACH—Ft. Knox
A
6,829
6,467
3,381
6,8290064
Bayne-Jones ACH—Ft. Polk
A
6,573
6,225
3,254
6,5730066
89th Med Grp—Andrews AFB
F
8,062
7,672
4,010
8,0620067
NNMC Bethesda
N
9,786
9,313
4,868
9,7860073
81st Med Grp—Keesler AFB
F
8,772
8,308
4,343
8,7720075
Wood ACH—Ft. Leonard Wood
A
6,539
6,193
3,237
6,5390078
55th Med Grp—Offutt AFB
F
8,697
8,236
4,306
8,6970079
99th Med Grp—Nellis AFB
F
6,002
5,712
2,986
6,0020083
377th Med Grp—Kirtland AFB
F
6,971
6,602
3,452
6,9710084
49th Med Grp—Holloman AFB
F
7,004
6,633
3,468
7,0040086
Keller ACH—West Point
A
7,296
6,909
3,612
7,2960089
Womack AMC—Ft. Bragg
A
7,817
7,403
3,870
7,8170091
NH Camp LeJeune
N
6,744
6,387
3,339
6,7440092
NH Cherry Point
N
6,788
6,429
3,361
6,7880093
319th Med Grp—Grand Forks AFB
F
7,032
6,660
3,482
7,0320094
5th Med Grp—Minot AFB
F
6,857
6,494
3,395
6,8570095
74th Med Grp—Wright-Patterson AFB
F
10,371
9,822
5,135
10,3710096
72nd Med Grp—Tinker AFB
F
6,001
5,711
2,985
6,0010097
97th Med Grp—Altus AFB
F
6,976
6,607
3,454
6,9760098
Reynolds ACH—Ft. Sill
A
6,831
6,469
3,382
6,8310100
NH Newport
N
6,002
5,712
2,986
6,0020101
20th Med Grp—Shaw AFB
F
6,964
6,595
3,448
6,9640103
NH Charleston
N
6,879
6,514
3,406
6,8790104
NH Beaufort
N
6,871
6,507
3,402
6,8710105
Moncrief ACH—Ft. Jackson
A
6,961
6,592
3,446
6,9610106
28th Med Grp—Ellsworth AFB
F
6,939
6,572
3,436
6,9390108
Wm Beaumont AMC—Ft. Bliss
A
8,329
7,888
4,124
8,3290109
Brooke AMC—Ft. Sam Houston
A
8,511
8,099
4,233
8,5110110
Darnall AH—Ft. Hood
A
8,606
8,151
4,261
8,6060112
7th Med Grp—Dyess AFB
F
6,892
6,528
3,413
6,8920113
82nd Med Grp—Sheppard AFB
F
6,903
6,537
3,418
6,9030117
59th Med Wing—Lackland AFB
F
8,640
8,222
4,297
8,6400119
75th Med Grp—Hill AFB
F
5,983
5,693
2,976
5,9830120
1st Med Grp—Langley AFB
F
5,954
5,666
*2,962*
5,9540121
McDonald ACH—Ft. Eustis
A
5,649
5,376
2,810
5,6490123
Dewitt AH—Ft. Belvoir
A
8,237
7,839
4,097
8,2370124
NH Portsmouth
N
7,469
7,107
3,715
7,4690125
Madigan AMC—Ft. Lewis
A
11,018
10,435
5,455
11,0180126
NH Bremerton
N
8,165
7,733
4,043
8,1650127
NH Oak Harbor
N
6,283
5,979
3,125
6,2830129
90th Med Grp—F.E. Warren AFB
F
6,989
6,619
3,460
6,989( print page 65032)0131
Weed ACH—Ft. Irwin
A
7,003
6,633
3,467
7,0030449
24th Med Grp—Howard
F
9,489
*9,045*
3,872
9,4890606
95th CSH—Heidelberg
A
9,489
9,045
3,872
9,4890607
Landstuhl Rgn MC
A
9,489
9,045
3,872
9,4890609
67th CSH—Wurzburg
A
9,489
9,045
3,872
9,4890612
121st Gen Hosp—Seoul
A
9,489
9,045
3,872
9,4890615
NH Guantanamo Bay
N
9,489
9,045
3,872
9,4890616
NH Roosevelt Roads
N
9,489
9,045
3,872
9,4890617
NH Naples
N
9,489
9,045
3,872
9,4890618
NH Rota
N
9,489
9,045
3,872
9,4890620
NH Guam
N
9,489
9,045
3,872
9,4890621
NH Okinawa
N
9,489
9,045
3,872
9,4890622
NH Yokosuka
N
9,489
9,045
3,872
9,4890623
NH Keflavik
N
9,489
9,045
3,872
9,4890624
BH Sigonella
N
9,489
9,045
3,872
9,4890633
48th Med Grp—RAF Lakenheath
F
9,489
*9,045*
*3,872*
*9,489*0635
39th Med Grp—Incirlik AB
F
9,489
*9,045*
*3,872*
*9,489*0638
51st Med Grp—Osan AB
F
9,489
9,045
3,872
9,4890639
35th Med Grp—Misawa
F
9,489
9,045
3,872
9,4890640
374th Med Grp—Yokota AB
F
9,489
9,045
3,872
9,4890805
52nd Med Grp—Spangdahlem
F
9,489
9,045
3,872
9,4890808
31st Med Grp—Aviano
F
9,489
9,045
3,872
9,489
 2. Department of Health and Human Services For the Department of Health and Human Services, Indian Health Service, effective October 1, 2000 and thereafter: Hospital Care Inpatient Day General Medical Care Alaska—$1,837 Rest of the United States—$1,357 Outpatient Medical Treatment Outpatient Visit Alaska—$337 Rest of the United States—$189 For the period beginning October 1, 2000, the rates prescribed herein superceded those established by the Director of the Office of Management and Budget, November 1, 1999 (64 FR 58862). Jacob J. Lew, Director, Office of Management and Budget.


[FR Doc. 00-27726 Filed 10-30-00; 8:45 am] BILLING CODE 3110-01-P