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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 two 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 and will remain in effect until further notice. The rates for VA that were published in the 
                    **Federal Register**
                     on October 31, 2000 remain in effect until further notice. The rates are as follows: 1. Department of Defense The 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 III.D.) and the rates for Ancillary Services Requested by Outside Providers (section III.E.) are not included in this package. Those rates are available from the TRICARE Management Activity's Uniform Business Office web site:
                    *http://www.tricare.osd.mil/​ebc/​rm_​home/​imcp/​ubo/​ubo_​01.htm.*
                     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, 2001. Pharmacy rates are updated on an as needed basis. 2. Health and Human Services The 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 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. 
                    ( print page 66478)
                    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, 2001 and thereafter: Inpatient, Outpatient and Other Rates and Charges I. Inpatient Rates 1 2 Per inpatient day
International military education & training (IMET)
Interagency & other Federal agency sponsored patients
Other (full/third party)A. Burn Center
$3,550.00
$6,156.00
$6,492.00B. All Other Inpatient Services (Based on Diagnosis Related Groups (DRG) 3
 1. Average FY 2002 Direct Care Inpatient Reimbursement Rates Adjusted standard amount
IMET
Interagency
Other
                             (full/third party)Large Urban
$3,625.00
$6,170.00
$6,486.00Other Urban/Rural
3,771.00
6,694.00
7,069.00Overseas
3,958.00
9,293.00
9,742.00
 2. Overview The 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.B.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. An outlier refers to a patient's LOS, which is either atypically short or long. They are determined by short or long stay outlier thresholds. Inliers, i.e., those patients who fall within the bounds of the outlier thresholds, receive DRG weights that represent their relative resource intensity. Each Military Treatment Facility (MTF) providing inpatient care has a separate 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. An example of how to apply a specific military treatment facility's ASA rate to a DRG standardized weight to arrive at the costs to be recovered is contained in paragraph I.B.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 Other Urban/Rural areas. a. The cost to be recovered is the MTF cost for medical services provided. Billings will be at the third party rate. b. DRG 020: Nervous System Infection Except Viral Meningitis. The RWP (i.e. the DoD measure of workload credit derived from biometrics dispositions weighted by CHAMPUS DRG weights) for an inlier case is the CHAMPUS weight of 2.0860. (DRG statistics shown are from FY 2000.) c. The MTF-applied ASA rate is $6,849.00 (Reynolds Army Community Hospital's third party rate as shown in Attachment 1). d. The MTF cost to be recovered is the RWP factor (2.0860) in subparagraph 3.b., above, multiplied by the amount ($6,849.00) in subparagraph 3.c., above which equals $14,287.00 e. Cost to be recovered is $14,287.00. Figure 1.—Third Party Billing Examples
DRG No.
DRG description
DRG weight
Arithmetic mean LOS
Geometric mean LOS
Short stay threshold
Long stay threshold020
Nervous System Infection Except Viral Meningitis
2.0860
7.7
5.5
1
29
 Hospital
Location
Area wage rate index
IME adjustment
Group ASA
MTF-Applied ASAReynolds Army Community Hospital
Other Urban/Rural
.8996
1.0
$7,069.00
$6,849.00
 Patient
Length of stay
Days above threshold
Relative weighted product
TPCInlier *
Outlier **
Total
Amount ***#1
7 days
0
2.0860
000
2.0860
$14,287.00#2
21 days
0
2.0860
000
2.0860
14,287.00( print page 66479)#3
35 days
6
2.0860
.7510
2.8370
19,431.00* DRG Weight** Outlier calculation = 33 percent of per diem weight X number of outlier days. The outlier must meet the criteria determined by the outlier threshold, i.e., the number of days beyond which hospitalization LOS is considered outside the typical range. These are specific for each DRG.=.33 (DRG Weight/Geometric Mean LOS) × (Patient LOS−Long Stay Threshold)=.33 (2.0860/5.5) × (35 - 29)=.33 (.37927) × 6 (take out to five decimal places)=.12516 X 6 (carry to five decimal places)=.7510 (carry to four decimal places)*** MTF-Applied ASA × Total RWP
 II. Outpatient Rates A. 
                        *Per Clinic Visit*
                         1
                         2 MEPRS Code 4
Clinical service
International military education & training (IMET)
Interagency & other federal agency sponsored patients
Other (full/third party)**1. Medical Care**BAA
Internal Medicine
$50.00
$199.00
$210.00BAB
Allergy
61.00
113.00
119.00BAC
Cardiology
107.00
199.00
209.00BAE
Diabetic
74.00
137.00
144.00BAF
Endocrinology (Metabolism)
124.00
231.00
243.00BAG
Gastroenterology
146.00
272.00
286.00BAH
Hematology
225.00
419.00
442.00BAI
Hypertension
198.00
369.00
388.00BAJ
Nephrology
180.00
334.00
352.00BAK
Neurology
136.00
254.00
267.00BAL
Outpatient Nutrition
51.00
95.00
100.00BAM
Oncology
158.00
294.00
310.00BAN
Pulmonary Disease
144.00
267.00
281.00BAO
Rheumatology
116.00
216.00
228.00BAP
Dermatology
93.00
172.00
182.00BAQ
Infectious Disease
151.00
282.00
297.00BAR
Physical Medicine
94.00
175.00
184.00BAS
Radiation Therapy
142.00
264.00
278.00BAT
Bone Marrow Transplant
154.00
287.00
302.00BAU
Genetic
343.00
639.00
673.00BAV
Hyperbaric
276.00
513.00
540.00**2. Surgical Care**BBA
General Surgery
162.00
302.00
318.00BBB
Cardiovascular and Thoracic Surgery
291.00
541.00
570.00BBC
Neurosurgery
169.00
314.00
331.00BBD
Ophthalmology
106.00
198.00
209.00BBE
Organ Transplant
717.00
1,335.00
1,406.00BBF
Otolaryngology
117.00
217.00
229.00BBG
Plastic Surgery
134.00
249.00
262.00BBH
Proctology
95.00
177.00
186.00BBI
Urology
131.00
244.00
257.00BBJ
Pediatric Surgery
72.00
133.00
140.00BBK
Peripheral Vascular Surgery
83.00
155.00
163.00BBL
Pain Management
113.00
210.00
222.00BBM
Vascular and Interventional Radiology
351.00
653.00
688.00**3. Obstetrical and Gynecological (OB-GYN) Care**BCA
Family Planning
75.00
139.00
146.00BCB
Gynecology
98.00
182.00
191.00BCC
Obstetrics
78.00
145.00
153.00BCD
Breast Cancer Clinic
147.00
274.00
289.00**4. Pediatric Care**BDA
Pediatric
71.00
133.00
140.00BDB
Adolescent
75.00
139.00
146.00BDC
Well Baby
49.00
91.00
96.00( print page 66480)**5. Orthopaedic Care**BEA
Orthopaedic
112.00
208.00
219.00BEB
Cast
63.00
117.00
123.00BEC
Hand Surgery
60.00
112.00
118.00BEE
Orthotic Laboratory
72.00
134.00
141.00BEF
Podiatry
63.00
117.00
124.00BEZ
Chiropractic
30.00
56.00
58.00**6. Psychiatric and/or Mental Health Care**BFA
Psychiatry
121.00
226.00
238.00BFB
Psychology
75.00
140.00
148.00BFC
Child Guidance
71.00
132.00
139.00BFD
Mental Health
118.00
219.00
231.00BFE
Social Work
113.00
211.00
222.00BFF
Substance Abuse
110.00
206.00
216.00**7. Family Practice/Primary Medical Care**BGA
Family Practice
84.00
156.00
165.00BHA
Primary Care
82.00
152.00
160.00BHB
Medical Examination
82.00
152.00
160.00BHC
Optometry
57.00
106.00
112.00BHD
Audiology
48.00
90.00
94.00BHE
Speech Pathology
91.00
169.00
178.00BHF
Community Health
67.00
125.00
131.00BHG
Occupational Health
90.00
167.00
176.00BHH
TRICARE Outpatient
58.00
108.00
114.00BHI
Immediate Care
113.00
211.00
222.00**8. Emergency Medical Care**BIA
Emergency Medical
142.00
264.00
278.00**9. Flight Medical Care**BJA
Flight Medicine
98.00
183.00
192.00**10. Underseas Medical Care**BKA
Underseas Medicine
57.00
107.00
113.00**11. Rehabilitative Services**BLA
Physical Therapy
43.00
81.00
85.00BLB
Occupational Therapy
87.00
162.00
70.00
 B. 
                        *Ambulatory Procedure Visit*
                         (APV)—
                        *Per Visit*
                         5 MEPRS Code 4
Clinical Service
International Military Education & Training (IMET)
Interagency & Other Federal Agency Sponsored Patients
Other (Full/Third Party)BB
Surgical Care
1,068.00
1,987.00
2,093.00BE
Orthopaedic Care
1,315.00
2,448.00
2,577.00All Other
B clinics other than BB and BE, to include those B clinics where:
                                 1. There is an APU established within DoD guidelines AND 
                                 2. There is a rate established for that clinic in section IIA. 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
297.00
553.00
582.00
 
 
 III. Other Rates and Charges 1 2 A. Per Each MEPRS code 4
Clinical service
International military education & training (IMET)
Interagency & other Federal agency sponsored patients
Other (full/third party)FBI
Immunization
$18.00
$34.00
$36.00B. 
                            *Family Member Rate*
                             (formerly Military Dependents Rate)
11.90C. 
                            *Subsistence Rate*
                            .15Standard Rate
8.10Discount Rate
6.75
 D. Reimbursement Rates For Drugs Requested By Outside Providers 6 E. Ancillary Services Requested by an Outside Provider—Per Procedure 7 MEPRS code 4
Clinical service
International military education & training (IMET)
Interagency & other Federal agency sponsored patients
Other (full/third party)DB
Laboratory procedures requested by an outside provider current procedural terminology (CPT) 2001 weight multiplier
$19.00
$28.00
$29.00DC, DI
Radiology procedures requested by an outside provider CPT 2001 weight multiplier
38.00
54.00
57.00
 F. Dental Rate—Per Procedure 11 MEPRS code 4
Clinical service
International military education & training (IMET)
Interagency & other Federal agency sponsored patients
Other (full/third party)Dental services ADA code weight multiplier
$31.00
$73.00
$77.00
 G. Ambulance Rate—Per Hour 12 MEPRS code 4
Clinical service
International military education & training (IMET)
Interagency & other Federal agency sponsored patients
Other (full/third party)FEA
Ambulance
$67.00
$124.00
$131.00
 H. AirEvac Rate—Per Trip (24 hour period) 13 MEPRS code 4
Clinical service
International military education & training (IMET)
Interagency & other Federal agency sponsored patients
Other (full/third party)AirEvac Services—Ambulatory
$257.00
$479.00
$505.00AirEvac Services—Litter
751.00
1,397.00
1,471.00
 I. Observation Rate—Per hour 14 MEPRS code 4
Clinical service
International military education & training (IMET)
Interagency & other Federal agency sponsored patients
Other (full/third party)Observation Services—Hour
$13.00
$24.00
$26.00
 
 
 IV. Elective Cosmetic Surgery Procedures and Rates Cosmetic surgery procedure
International classification diseases (ICD-9)
Current procedural terminology (CPT) 8
FY 2002 charge 9
Amount of ChargeMammaplasty—augmentation
85.50, 85.32, 85.31
19325, 19324, 19318
Inpatient Charge per DRG or APV
(a
                            )
                             
                                (b
                                )Mastopexy
85.60
19316
Inpatient Charge per DRG Or APV or applicable Outpatient Clinic Rate
(a b c)Facial Rhytidectomy
86.82, 86.22
15824
Inpatient Charge per DRG or APV
(a b)Blepharoplasty
08.70, 08.44
15820, 15821, 15822, 15823
Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate
(a b c)Mentoplasty (Augmentation/Reduction)
76.68, 76.67
21208, 21209
Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate
(a b c)Abdominoplasty
86.83
15831
Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate
(a b c)Lipectomy Suction per region 10
86.83
15876, 15877, 15878, 15879
Inpatient Charge per DRG or APV or applicable Outpatient Clinic RateRhinoplasty
21.87, 21.86
30400, 30410
Inpatient Charge per DRG Or APV or applicable Outpatient Clinic Rate
(a b c)Scar Revisions beyond CHAMPUS
86.84
1578
Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate
(a b c)Mandibular or Maxillary Repositioning
76.41
21194
Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate
(a b c)Dermabrasion
86.25
15780
Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate
(a b c)Hair Restoration
86.64
15775
Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate
(a b c)Removing Tattoos
86.25
15780
Inpatient Charge per DRG or APV or applicable Outpatient Clinic Rate
(a b c)Chemical peel
86.24
15790
Inpatient charge per DRG or APV or applicable Outpatient clinic rate
(a b c)Arm/thigh dermolipectomy
86.83
15836/15832
Inpatient charge per DRG or APV
(a b)Refractive surgery


APV or applicable outpatient clinic rate
(b c e)Radial 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 charge per DRG or APV or applicable outpatient clinic rate
(a b c)
 Notes on Cosmetic Surgery Charges a
                         Charges for Inpatient surgical care services are based on the cost per DRG. (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 II.B. (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. 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 Office of the Assistant Secretary of Defense (Health Affairs) 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 96 percent hospital and 4 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 Centers for Medicare and Medicaid Services (CMS) 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.B.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 digit code which defines the summary account and the subaccount 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: 
                        ( print page 66483)
                        Outpatient Care (Functional Category), B (MEPRS CODE), Medical Care (Summary Account), BA (MEPRS CODE), Internal Medicine (Subaccount), BAA (MEPRS CODE). 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 cannot be defined and an APV cannot 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 MTFs 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 lowest cost for the generic drugs with the same dosage and strength. 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 web site, 
                        *http://www.tricare.osd.mil/​ebc/​rm_​home/​imcp/​ubo/​ubo_​01.htm.* 7
                         The list of 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_​home/​imcp/​ubo/​ubo_​01.htm. 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) 2001 code by either the laboratory or radiology multiplier (section III.E.). 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 2001 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 IV. The patient shall be charged the rate as specified in the FY 2002 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 care services based on the cost per DRG, ambulatory procedure visits as contained in section II.B. or the appropriate outpatient clinic rate in sections II.A. 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 $11.55 ($77 × .15 = $11.55). The list of 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 web site, 
                        *http://www.tricare.osd.mil/​ebc/​rm_​home/​imcp/​ubo/​ubo_​01.htm.* 12
                         Ambulance charges shall be based on hours of service in 15 minute increments. The rates listed in section III.G. 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 1 hour and 20 minutes of observation, then you bill for 1 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
                         Subsistence is billed under the Medical Services Account (MSA) Program only. The MSA office shall collect subsistence charges from all persons, including inpatients and transient patients not entitled to food service at Government expense. Please refer to DoD 6010.15-M, Military Treatment Facility Uniform Business Office (UBO) Manual, April 1997 and the DoD 7000.14-R, “Department of Defense Financial Management Regulation”, Volume 12, Chapter 19 for guidance on the the use of these rates. Attachment 1.—FY02 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
$6,703
$6,348
$3,576
$6,7030005
Bassett ACH—Ft. Wainwright
A
7,241
6,856
3,863
7,2410006
3rd Med Grp—Elmendorf AFB
F
7,109
6,732
3,793
7,109( print page 66484)0009
56th Med Grp—Luke AFB
F
6,474
6,159
3,618
6,4740014
60th Med Grp—Travis AFB
F
9,946
9,419
5,306
9,9460024
NH Camp Pendleton
N
8,687
8,264
4,855
8,6870028
NH Lemoore
N
7,034
6,661
3,752
7,0340029
NH San Diego
N
10,904
10,374
6,094
10,9040030
NH Twenty Nine Palms
N
6,596
6,274
3,686
6,5960032
Evans ACH—Ft. Carson
A
6,985
6,615
3,726
6,9850033
10th Med Grp—USAF Academy
F
7,062
6,687
3,767
7,0620037
Walter Reed AMC—Washington DC
A
10,384
9,878
5,803
10,3840038
NH Pensacola
N
8,704
8,242
4,643
8,7040039
NH Jacksonville
N
8,539
8,123
4,772
8,5390042
96th Med Grp—Eglin AFB
F
8,747
8,283
4,666
8,7470045
6th Med Grp—MacDill AFB
F
6,482
6,167
3,623
6,4820047
Eisenhower AMC—Ft. Gordon
A
8,677
8,217
4,629
8,6770048
Martin ACH—Ft. Benning
A
8,118
7,688
4,331
8,1180049
Winn ACH—Ft. Stewart
A
6,989
6,618
3,728
6,9890052
Tripler AMC—Ft. Shafter
A
10,134
9,597
5,406
10,1340053
366th Med Grp—Mountain Home AFB
F
7,056
6,682
3,764
7,0560055
375th Med Grp—Scott AFB
F
8,579
8,161
4,794
8,5790056
NH Great Lakes
N
6,538
6,220
3,654
6,5380057
Irwin AH—Ft. Riley
A
6,498
6,154
3,467
6,4980060
Blanchfield ACH—Ft Campbell
A
6,577
6,228
3,509
6,5770061
Ireland ACH—Ft. Knox
A
6,467
6,124
3,450
6,4670064
Bayne-Jones ACH—Ft. Polk
A
6,602
6,252
3,522
6,6020066
89th Med Grp—Andrews AFB
F
8,807
8,378
4,922
8,8070067
NNMC Bethesda
N
10,913
10,382
6,099
10,9130073
81st Med Grp—Keesler AFB
F
10,213
9,671
5,448
10,2130075
Wood ACH—Ft. Leonard Wood
A
6,572
6,223
3,506
6,5720078
55th Med Grp—Offutt AFB
F
9,245
8,755
4,932
9,2450079
99th Med Grp—Nellis AFB
F
6,495
6,179
3,630
6,4950084
49th Med Grp—Holloman AFB
F
7,068
6,693
3,771
7,0680086
Keller ACH—West Point
A
7,342
6,953
3,917
7,3420089
Womack AMC—Ft. Bragg
A
7,586
7,184
4,047
7,5860091
NH Camp LeJeune
N
6,694
6,339
3,571
6,6940092
NH Cherry Point
N
6,809
6,448
3,632
6,8090093
319th Med Grp—Grand Forks AFB
F
6,966
**6,597**
3,716
6,9660094
5th Med Grp—Minot AFB
F
6,965
6,595
3,715
6,9650095
74th Med Grp—Wright-Patterson AFB
F
11,385
10,781
6,073
11,3850098
Reynolds ACH—Ft. Sill
A
6,849
6,486
3,654
6,8490100
NH Newport
N
6,486
6,170
3,625
6,4860101
20th Med Grp—Shaw AFB
F
7,028
6,656
3,749
7,0280104
NH Beaufort
N
6,940
6,572
3,702
6,9400105
Moncrief ACH—Ft. Jackson
A
7,011
6,639
3,740
7,0110106
28th Med Grp—Ellsworth AFB
F
7,049
6,675
3,760
7,0490108
Wm Beaumont AMC—Ft. Bliss
A
8,575
8,120
4,575
8,5750109
Brooke AMC—Ft. Sam Houston
A
9,404
8,946
5,255
9,4040110
Darnall AH—Ft. Hood
A
7,904
7,485
4,216
7,9040112
7th Med Grp— Dyess AFB
F
6,999
6,628
3,734
6,9990113
82nd Med Grp—Sheppard AFB
F
6,970
6,600
3,718
6,9700117
59th Med Wing F—Lackland AFB
F
9,977
9,491
5,575
9,9770120
1st Med Grp—Langley AFB
F
6,421
6,108
3,588
6,4210121
McDonald ACH—Ft. Eustis
A
6,103
5,806
3,411
6,1030123
Dewitt AH—Ft. Belvoir
A
8,131
7,735
4,544
8,1310124
NH Portsmouth
N
8,355
7,949
4,669
8,3550125
Madigan AMC—Ft. Lewis
A
11,847
11,218
6,320
11,8470126
NH Bremerton
N
8,400
7,955
4,481
8,4000127
NH Oak Harbor
N
6,709
6,382
3,749
6,7090131
Weed ACH—Ft. Irwin
A
7,064
6,689
3,769
7,0640606
95th CSH—Heidelberg
A
9,742
9,293
3,958
9,7420607
Landstuhl Rgn MC
A
9,742
9,293
3,958
9,7420609
67th CSH—Wurzburg
A
9,742
9,293
3,958
9,7420612
121st Gen Hosp—Seoul
A
9,742
9,293
3,958
9,7420615
NH Guantanamo Bay
N
9,742
9,293
3,958
9,7420616
NH Roosevelt Roads
N
9,742
9,293
3,958
9,7420617
NH Naples
N
9,742
9,293
3,958
9,7420618
NH Rota
N
9,742
9,293
3,958
9,7420620
NH Guam
N
9,742
9,293
3,958
9,7420621
NH Okinawa
N
9,742
9,293
3,958
9,7420622
NH Yokosuka
N
9,742
9,293
3,958
9,7420623
NH Keflavik
N
9,742
9,293
3,958
9,7420624
BH Sigonella
N
9,742
9,293
3,958
9,742( print page 66485)0633
48th Med Grp—RAF Lakenheath
F
9,742
9,293
3,958
9,7420635
39th Med Grp—Incirlik AB
F
9,742
9,293
3,958
9,7420638
51st Med Grp—Osan AB
F
9,742
9,293
3,958
9,7420639
35th Med Grp—Misawa
F
9,742
9,293
3,958
9,7420640
374th Med Grp—Yokota AB
F
9,742
9,293
3,958
9,7420805
52nd Med Grp—Spangdahlem
F
9,742
9,293
3,958
9,7420808
31st Med Grp—Aviano
F
9,742
9,293
3,958
9,742
 2. Department of Health and Human Services For the Department of Health and Human Services, Indian Health Service, effective October 1, 2001 and thereafter: *Hospital Care Inpatient Day*General Medical CareAlaska
$2,025Rest of the United States
1,571*Outpatient Medical Treatment*Outpatient VisitAlaska
363Rest of the United States
196
 Beginning October 1, 2001, the rates prescribed herein superceded those established by the Director of the Office of Management and Budget October 31, 2000 (FR Doc. 00-27726). Mitchell Daniels, Jr., Director, Office of Management and Budget.


[FR Doc. 01-31663 Filed 12-21-01; 8:45 am] BILLING CODE 3110-01-P