Federal Register: October 31, 2000 (Volume 65, Number 211)

DOCID: FR Doc 00-27726

OFFICE OF MANAGEMENT AND BUDGET

Management and Budget Office

NOTICE: NOTICES

SUBJECT CATEGORY:

Cost of Hospital and Medical Care Treatment Furnished by the United States; Certain Rates Regarding Recovery From Tortiously Liable Third Persons

DOCUMENT SUMMARY:

By virtue of the authority vested in the President by Section 2(a) of Public Law 87693 (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
[[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 A25.

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
International Interagency and Military other Federal Other (full/ Per inpatient day Education and agency sponsored third party) Training (IMET) patients A. Burn Center......................................... $4,144.00 $5,694.00 $6,016.00 B. Surgical Care Services (Cosmetic Surgery)........... 1,895.00 2,604.00 2,752.00 C. All Other Inpatient Services (Based on Diagnosis
Related Groups (DRG) \3\..............................
Average FY01 Direct Care Inpatient Reimbursement Rates
Other (full/ Adjusted standard amount IMET Interagency third party) Large Urban............................................... $2,986.00 $5,712.00 $6,002.00 Other Urban/Rural......................................... 3,468.00 6,633.00 7,004.00 Overseas.................................................. 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 rateThe MTFspecific 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 MTFspecific 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 MTFASAs and how they are applied refer to the ASA Primer at http://www.tricare.osd.mil/org/pae/asaprimer/asa primer1.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 nonteaching 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 MTFapplied 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.
[[Page 65026]]
Figure 1.Third Party Billing Examples Arithmetic Geometric Short stay Long stay DRG number DRG description DRG weight mean LOS mean LOS threshold threshold 020................................... Nervous System Infection Except Viral 2.2244 8.3 5.8 1 29 Meningitis.
Area wage IME MTFapplied Hospital Location rate index adjustment Group ASA ASA Reynolds Army Community Hospital.............. Other urban/rural............................. .9156 1.0 $7,004 $6,831 Length of Relative weighted product Patient stay Days above TPC (days) threshold Inlier\*\ Outlier\**\ Total Amount\***\ #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 x number of outlier days = .33 (DRG Weight/Geometric Mean LOS) x (Patient LOSLong Stay Threshold) = .33 (2.2244/5.8) x (3529)
= .33 (.38352) x 6 (take out to five decimal places)
= .12656 x 6 (carry to five decimal places)
= .7594 (carry to four decimal places)
\***\ MTFApplied ASA x Total RWP
II. Outpatient Rates [Per Visit 1,2] Interagency and International other federal MEPRS code \4\ Clinical service military agency Other (full/ education and sponsored third party) training (IMET) patients A. Medical Care:
BAA........................ Internal Medicine.............. $147.00 $204.00 $216.00 BAB........................ Allergy........................ 80.00 111.00 117.00 BAC........................ Cardiology..................... 129.00 180.00 190.00 BAE........................ Diabetic....................... 105.00 146.00 154.00 BAF........................ Endocrinology (Metabolism)..... 151.00 210.00 222.00 BAG........................ Gastroenterology............... 183.00 255.00 269.00 BAH........................ Hematology.................... 286.00 398.00 420.00 BAI........................ Hypertension.................. 216.00 301.00 318.00 BAJ........................ Nephrology.................... 221.00 307.00 324.00 BAK........................ Neurology..................... 165.00 229.00 242.00 BAL........................ Outpatient Nutrition.......... 69.00 96.00 101.00 BAM........................ Oncology...................... 201.00 280.00 295.00 BAN........................ Pulmonary Disease............. 186.00 259.00 273.00 BAO........................ Rheumatology.................. 139.00 194.00 205.00 BAP........................ Dermatology................... 115.00 160.00 169.00 BAQ........................ Infectious Disease............ 181.00 252.00 266.00 BAR........................ Physical Medicine............. 115.00 160.00 169.00 BAS........................ Radiation Therapy............. 169.00 235.00 248.00 BAT........................ Bone Marrow Transplant........ 190.00 264.00 279.00 BAU........................ Genetic....................... 330.00 460.00 485.00 BAV........................ Hyperbaric.................... 344.00 480.00 506.00 B. Surgical Care:
BBA........................ General Surgery............... 215.00 299.00 316.00 BBB........................ Cardiovascular and Thoracic 419.00 584.00 616.00 Surgery.
BBC........................ Neurosurgery................... 249.00 347.00 366.00 BBD........................ Ophthalmology................. 130.00 181.00 191.00 BBE........................ Organ Transplant.............. 1,106.00 1,541.00 1,625.00 BBF........................ Otolaryngology................ 149.00 207.00 219.00 BBG........................ Plastic Surgery............... 168.00 235.00 247.00 BBH........................ Proctology.................... 125.00 174.00 184.00 BBI........................ Urology....................... 164.00 228.00 240.00 BBJ........................ Pediatric Surgery............. 89.00 125.00 131.00 BBK........................ Peripheral Vascular Surgery... 98.00 137.00 145.00 BBL........................ Pain Management............... 138.00 193.00 203.00 BBM........................ Vascular and Interventional 493.00 687.00 724.00 Radiology.
C. Obstetrical and
Gynecological (OBGYN) Care:
BCA........................ Family Planning............... 76.00 106.00 111.00 [[Page 65027]]
BCB........................ Gynecology.................... 127.00 177.00 187.00 BCC........................ Obstetrics.................... 104.00 144.00 152.00 BCD........................ Breast Cancer Clinic........... 240.00 334.00 352.00 D. Pediatric Care:
BDA........................ Pediatric..................... 92.00 128.00 134.00 BDB........................ Adolescent.................... 83.00 115.00 121.00 BDC........................ Well Baby..................... 63.00 87.00 92.00 E. Orthopaedic Care:
BEA........................ Orthopaedic................... 143.00 200.00 211.00 BEB........................ Cast.......................... 89.00 123.00 130.00 BEC........................ Hand Surgery.................. 76.00 106.00 112.00 BEE........................ Orthotic Laboratory........... 93.00 130.00 137.00 BEF........................ Podiatry...................... 80.00 112.00 118.00 BEZ........................ Chiropractic.................. 38.00 53.00 55.00 F. Psychiatric and/or Mental Health Care:
BFA........................ Psychiatry..................... 165.00 230.00 242.00 BFB........................ Psychology.................... 115.00 160.00 169.00 BFC........................ Child Guidance................ 92.00 128.00 135.00 BFD........................ Mental Health................. 148.00 206.00 217.00 BFE........................ Social Work................... 147.00 205.00 217.00 BFF........................ Substance Abuse............... 141.00 197.00 208.00 G. Family Practice/Primary
Medical Care:
BGA........................ Family Practice............... 107.00 149.00 157.00 BHA........................ Primary Care.................. 109.00 151.00 160.00 BHB........................ Medical Examination........... 111.00 155.00 163.00 BHC........................ Optometry..................... 72.00 100.00 105.00 BHD........................ Audiology..................... 52.00 73.00 77.00 BHE........................ Speech Pathology.............. 122.00 170.00 180.00 BHF........................ Community Health.............. 85.00 118.00 125.00 BHG........................ Occupational Health........... 108.00 151.00 159.00 BHH........................ TRICARE Outpatient............ 74.00 104.00 109.00 BHI........................ Immediate Care................ 161.00 225.00 237.00 H. Emergency Medical Care:
BIA........................ Emergency Medical............. 173.00 242.00 255.00 I. Flight Medical Care:
BJA........................ Flight Medicine............... 124.00 173.00 182.00 J. Underseas Medical Care:
BKA........................ Underseas Medicine............ 77.00 108.00 114.00 K. Rehabilitative Services:
BLA........................ Physical Therapy.............. 56.00 79.00 83.00 BLB........................ Occupational Therapy.......... 75.00 104.00 110.00 III. Ambulatory Procedure Visit (APV) [Per visit \5\] Interagency and International other federal MEPRS code \4\ Clinical service military agency Other (full/ education and sponsored third party) training (IMET) patients Medical Care:
BB.......................... Surgical Care.................. $1,313.00 $1,829.00 $1,929.00 BE.......................... Orthopaedic Care............... 1,664.00 2,319.00 2,446.00 All Other................... B clinics other than BB and BE, 378.00 527.00 556.00 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 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.
[[Page 65028]]
IV. Other Rates and Charges \1\ \2\ Interagency and International other federal MEPRS code \4\ Clinical service military agency Other (full/ education and sponsored third party) training (IMET) patients A. Per Each:
FBI......................... Immunization................... $22.00 $31.00 $32.00 B. 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 ProviderPer
Procedure: \7\ \15\
DB.......................... Laboratory procedures requested 15.00 22.00 23.00 by an outside provider CPT '00 Weight Multiplier.
DC, DI...................... Radiology procedures requested 79.00 115.00 120.00 by an outside provider CPT '00 Weight Multiplier.
E. Dental RatePer Procedure:
\11\
Dental Services ADA code weight 73.00 112.00 117.00 multiplier.
F. Ambulance RatePer Hour:
\12\
FEA......................... Ambulance...................... 81.00 113.00 120.00 G. AirEvac RatePer Trip (24
hour period): \13\
AirEvac ServicesAmbulatory 339.00 473.00 499.00 AirEvac ServicesLitter....... 989.00 1,379.00 1,454.00 H. Observation RatePer hour
\14\
Observation ServicesHour..... 20.00 28.00 30.00 V. Elective Cosmetic Surgery Procedures and Rates International Current classification procedural Cosmetic surgery procedure diseases (ICD terminology FY 2001 Charge \9\ Amount of charge 9) (CPT) \8\ Mammaplastyaugmentation........... 85.50 19325 Inpatient Surgical (a) Care Per Diem or APV (b) 85.32 19324 85.31 19318 Mastopexy........................... 85.60 19316 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Facial.............................. 86.82 15824 Inpatient Surgical (a) Care Per Diem or APV (b) Rhytidectomy........................ 86.22
Blepharoplasty...................... 08.70 15820 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate 08.44 15821 15822 15823 Mentoplasty (Augmentation/or 76.68 21208 Inpatient Surgical (a) Reduction). Care Per Diem APV or (b) applicable Outpatient (c) Clinic Rate 76.67 21209 Abdominoplasty...................... 86.83 15831 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Lipectomy........................... 86.83 15876 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Suction per region 10............... 15877 15878 15879 Rhinoplasty......................... 21.87 30400 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate 21.86 30410 [[Page 65029]]
Scar Revisions beyond CHAMPUS....... 86.84 1578__ Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Mandibular or Maxillary 76.41 21194 Inpatient Surgical (a) Repositioning. Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Dermabrasion........................ 86.25 15780 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Hair Restoration.................... 86.64 15775 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Removing Tattoos.................... 86.25 15780 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Chemical Peel....................... 86.24 15790 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Arm/Thigh: Dermolipectomy........... 86.83 15836/ Inpatient Surgical (a) Care Per Diem or APV (b) APV or applicable (b) Outpatient Clinic (c) Rate (e) Refractive surgery.................. ............... 15832 Radial Keratotomy................... ............... 65771

Other Procedure (if applies to ............... 66999 laser or other.

refractive surgery).............
Otoplasty........................... ............... 69300 APV or applicable (b) Outpatient Clinic (c) Rate Brow Lift........................... 86.3 15839 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate 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.AK. 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 NonActive 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 in \1\ 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
[[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 Code Outpatient 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) preprocedure and immediate postprocedure 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 MTFestablished 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 (see \4\ 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 DoDwide 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.AK. 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 x .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 inflight 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.
[[Page 65031]]
Attachment 1.Adjusted Standardized Amounts (ASA) By Military Treatment Facility Full cost Interagency IMET TPC DMISID MTF name Serv rate rate rate rate 0003................ Lyster AHFt. Rucker......... A.............. $6,637 $6,286 $3,286 $6,637 0004................ 502nd Med GrpMaxwell AFB.... F.............. 6,984 6,614 3,458 6,984 0005................ Bassett ACHFt. Wainwright... A.............. 7,152 6,774 3,541 7,152 0006................ 3rd Med GrpElmendorf AFB.... F.............. 7,041 6,668 3,486 7,041 0009................ 56th Med GrpLuke AFB........ F.............. 5,986 5,697 2,978 5,986 0014................ 60th Med GrpTravis AFB...... F.............. 9,912 9,387 4,907 9,912 0018................ 30th Med GrpVandenberg AFB.. F.............. 7,035 6,663 3,483 7,035 0019................ 95th Med GrpEdwards AFB..... F.............. 7,004 6,633 3,468 7,004 0024................ NH Camp Pendleton............. N.............. 7,614 7,245 3,787 7,614 0028................ NH Lemoore.................... N.............. 6,997 6,627 3,465 6,997 0029................ NH San Diego.................. N.............. 9,744 9,273 4,847 9,744 0030................ NH Twenty Nine Palms.......... N.............. 6,111 5,815 3,039 6,111 0032................ Evans ACHFt. Carson......... A.............. 6,946 6,578 3,439 6,946 0033................ 10th Med GrpUSAF Academy.... F.............. 6,994 6,623 3,463 6,994 0037................ Walter Reed AMC Washington A.............. 9,010 8,574 4,482 9,010 DC.
0038................ NH Pensacola.................. N.............. 8,939 8,465 4,426 8,939 0039................ NH Jacksonville............... N.............. 7,537 7,173 3,749 7,537 0042................ 96th Med GrpEglin AFB....... F.............. 8,309 7,869 4,114 8,309 0043................ 325th Med GrpTyndall AFB.... F.............. 7,002 6,631 3,467 7,002 0045................ 6th Med GrpMacDill AFB...... F.............. 5,991 5,702 2,980 5,991 0047................ Eisenhower AMCFt. Gordon.... A.............. 8,550 8,098 4,233 8,550 0048................ Martin ACHFt. Benning....... A.............. 7,987 7,564 3,954 7,987 0049................ Winn ACHFt. Stewart......... A.............. 6,644 6,292 3,289 6,644 0052................ Tripler AMCFt. Shafter...... A.............. 9,533 9,029 4,720 9,533 0053................ 366th Med GrpMountain Home F.............. 6,982 6,612 3,457 6,982 AFB.
0055................ 375th Med GrpScott AFB...... F.............. 7,625 7,256 3,793 7,625 0056................ NH Great Lakes................ N.............. 6,063 5,770 3,016 6,063 0057................ Irwin AHFt. Riley........... A.............. 6,521 6,176 3,229 6,521 0060................ Blanchfield ACHFt. Campbell. A.............. 6,605 6,255 3,270 6,605 0061................ Ireland ACHFt. Knox......... A.............. 6,829 6,467 3,381 6,829 0064................ BayneJones ACHFt. Polk..... A.............. 6,573 6,225 3,254 6,573 0066................ 89th Med GrpAndrews AFB..... F.............. 8,062 7,672 4,010 8,062 0067................ NNMC Bethesda................. N.............. 9,786 9,313 4,868 9,786 0073................ 81st Med GrpKeesler AFB..... F.............. 8,772 8,308 4,343 8,772 0075................ Wood ACHFt. Leonard Wood.... A.............. 6,539 6,193 3,237 6,539 0078................ 55th Med GrpOffutt AFB...... F.............. 8,697 8,236 4,306 8,697 0079................ 99th Med GrpNellis AFB...... F.............. 6,002 5,712 2,986 6,002 0083................ 377th Med GrpKirtland AFB... F.............. 6,971 6,602 3,452 6,971 0084................ 49th Med GrpHolloman AFB... F.............. 7,004 6,633 3,468 7,004 0086................ Keller ACHWest Point........ A.............. 7,296 6,909 3,612 7,296 0089................ Womack AMCFt. Bragg......... A.............. 7,817 7,403 3,870 7,817 0091................ NH Camp LeJeune............... N.............. 6,744 6,387 3,339 6,744 0092................ NH Cherry Point............... N.............. 6,788 6,429 3,361 6,788 0093................ 319th Med GrpGrand Forks F.............. 7,032 6,660 3,482 7,032 AFB.
0094................ 5th Med GrpMinot AFB........ F.............. 6,857 6,494 3,395 6,857 0095................ 74th Med GrpWright F............. 10,371 9,822 5,135 10,371 Patterson AFB.
0096................ 72nd Med GrpTinker AFB...... F.............. 6,001 5,711 2,985 6,001 0097................ 97th Med GrpAltus AFB....... F.............. 6,976 6,607 3,454 6,976 0098................ Reynolds ACHFt. Sill........ A.............. 6,831 6,469 3,382 6,831 0100................ NH Newport.................... N.............. 6,002 5,712 2,986 6,002 0101................ 20th Med GrpShaw AFB........ F.............. 6,964 6,595 3,448 6,964 0103................ NH Charleston................. N.............. 6,879 6,514 3,406 6,879 0104................ NH Beaufort................... N.............. 6,871 6,507 3,402 6,871 0105................ Moncrief ACHFt. Jackson..... A.............. 6,961 6,592 3,446 6,961 0106................ 28th Med GrpEllsworth AFB... F.............. 6,939 6,572 3,436 6,939 0108................ Wm Beaumont AMCFt. Bliss.... A.............. 8,329 7,888 4,124 8,329 0109................ Brooke AMCFt. Sam Houston.. A.............. 8,511 8,099 4,233 8,511 0110................ Darnall AHFt. Hood.......... A.............. 8,606 8,151 4,261 8,606 0112................ 7th Med GrpDyess AFB........ F.............. 6,892 6,528 3,413 6,892 0113................ 82nd Med GrpSheppard AFB.... F.............. 6,903 6,537 3,418 6,903 0117................ 59th Med WingLackland AFB... F.............. 8,640 8,222 4,297 8,640 0119................ 75th Med GrpHill AFB........ F.............. 5,983 5,693 2,976 5,983 0120................ 1st Med GrpLangley AFB...... F.............. 5,954 5,666 2,962 5,954 0121................ McDonald ACHFt. Eustis...... A.............. 5,649 5,376 2,810 5,649 0123................ Dewitt AHFt. Belvoir........ A.............. 8,237 7,839 4,097 8,237 0124................ NH Portsmouth................. N.............. 7,469 7,107 3,715 7,469 0125................ Madigan AMCFt. Lewis........ A.............. 11,018 10,435 5,455 11,018 0126................ NH Bremerton.................. N.............. 8,165 7,733 4,043 8,165 0127................ NH Oak Harbor................. N.............. 6,283 5,979 3,125 6,283 0129................ 90th Med GrpF.E. Warren AFB. F.............. 6,989 6,619 3,460 6,989 [[Page 65032]]
0131................ Weed ACHFt. Irwin........... A.............. 7,003 6,633 3,467 7,003 0449................ 24th Med GrpHoward.......... F.............. 9,489 9,045 3,872 9,489 0606................ 95th CSHHeidelberg.......... A.............. 9,489 9,045 3,872 9,489 0607................ Landstuhl Rgn MC.............. A.............. 9,489 9,045 3,872 9,489 0609................ 67th CSHWurzburg............ A.............. 9,489 9,045 3,872 9,489 0612................ 121st Gen HospSeoul......... A.............. 9,489 9,045 3,872 9,489 0615................ NH Guantanamo Bay............. N.............. 9,489 9,045 3,872 9,489 0616................ NH Roosevelt Roads............ N.............. 9,489 9,045 3,872 9,489 0617................ NH Naples..................... N.............. 9,489 9,045 3,872 9,489 0618................ NH Rota....................... N.............. 9,489 9,045 3,872 9,489 0620................ NH Guam....................... N.............. 9,489 9,045 3,872 9,489 0621................ NH Okinawa.................... N.............. 9,489 9,045 3,872 9,489 0622................ NH Yokosuka................... N.............. 9,489 9,045 3,872 9,489 0623................ NH Keflavik................... N.............. 9,489 9,045 3,872 9,489 0624................ BH Sigonella.................. N.............. 9,489 9,045 3,872 9,489 0633................ 48th Med GrpRAF Lakenheath.. F.............. 9,489 9,045 3,872 9,489 0635................ 39th Med GrpIncirlik AB..... F.............. 9,489 9,045 3,872 9,489 0638................ 51st Med GrpOsan AB......... F.............. 9,489 9,045 3,872 9,489 0639................ 35th Med GrpMisawa.......... F.............. 9,489 9,045 3,872 9,489 0640................ 374th Med GrpYokota AB...... F.............. 9,489 9,045 3,872 9,489 0805................ 52nd Med GrpSpangdahlem..... F.............. 9,489 9,045 3,872 9,489 0808................ 31st Med GrpAviano.......... 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. 0027726 Filed 103000; 8:45 am] BILLING CODE 311001P

SUMMARY:

Hospital and medical care and treatment furnished by United States, costs; rates regarding recovery from tortiously liable third persons (Circular A-25),

DOCUMENT BODY 2:

By virtue of the authority vested in the President by Section 2(a) of Public Law 87693 (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
[[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 A25.

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
International Interagency and Military other Federal Other (full/ Per inpatient day Education and agency sponsored third party) Training (IMET) patients A. Burn Center......................................... $4,144.00 $5,694.00 $6,016.00 B. Surgical Care Services (Cosmetic Surgery)........... 1,895.00 2,604.00 2,752.00 C. All Other Inpatient Services (Based on Diagnosis
Related Groups (DRG) \3\..............................
Average FY01 Direct Care Inpatient Reimbursement Rates
Other (full/ Adjusted standard amount IMET Interagency third party) Large Urban............................................... $2,986.00 $5,712.00 $6,002.00 Other Urban/Rural......................................... 3,468.00 6,633.00 7,004.00 Overseas.................................................. 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 rateThe MTFspecific 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 MTFspecific 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 MTFASAs and how they are applied refer to the ASA Primer at http://www.tricare.osd.mil/org/pae/asaprimer/asa primer1.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 nonteaching 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 MTFapplied 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.
[[Page 65026]]
Figure 1.Third Party Billing Examples Arithmetic Geometric Short stay Long stay DRG number DRG description DRG weight mean LOS mean LOS threshold threshold 020................................... Nervous System Infection Except Viral 2.2244 8.3 5.8 1 29 Meningitis.
Area wage IME MTFapplied Hospital Location rate index adjustment Group ASA ASA Reynolds Army Community Hospital.............. Other urban/rural............................. .9156 1.0 $7,004 $6,831 Length of Relative weighted product Patient stay Days above TPC (days) threshold Inlier\*\ Outlier\**\ Total Amount\***\ #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 x number of outlier days = .33 (DRG Weight/Geometric Mean LOS) x (Patient LOSLong Stay Threshold) = .33 (2.2244/5.8) x (3529)
= .33 (.38352) x 6 (take out to five decimal places)
= .12656 x 6 (carry to five decimal places)
= .7594 (carry to four decimal places)
\***\ MTFApplied ASA x Total RWP
II. Outpatient Rates [Per Visit 1,2] Interagency and International other federal MEPRS code \4\ Clinical service military agency Other (full/ education and sponsored third party) training (IMET) patients A. Medical Care:
BAA........................ Internal Medicine.............. $147.00 $204.00 $216.00 BAB........................ Allergy........................ 80.00 111.00 117.00 BAC........................ Cardiology..................... 129.00 180.00 190.00 BAE........................ Diabetic....................... 105.00 146.00 154.00 BAF........................ Endocrinology (Metabolism)..... 151.00 210.00 222.00 BAG........................ Gastroenterology............... 183.00 255.00 269.00 BAH........................ Hematology.................... 286.00 398.00 420.00 BAI........................ Hypertension.................. 216.00 301.00 318.00 BAJ........................ Nephrology.................... 221.00 307.00 324.00 BAK........................ Neurology..................... 165.00 229.00 242.00 BAL........................ Outpatient Nutrition.......... 69.00 96.00 101.00 BAM........................ Oncology...................... 201.00 280.00 295.00 BAN........................ Pulmonary Disease............. 186.00 259.00 273.00 BAO........................ Rheumatology.................. 139.00 194.00 205.00 BAP........................ Dermatology................... 115.00 160.00 169.00 BAQ........................ Infectious Disease............ 181.00 252.00 266.00 BAR........................ Physical Medicine............. 115.00 160.00 169.00 BAS........................ Radiation Therapy............. 169.00 235.00 248.00 BAT........................ Bone Marrow Transplant........ 190.00 264.00 279.00 BAU........................ Genetic....................... 330.00 460.00 485.00 BAV........................ Hyperbaric.................... 344.00 480.00 506.00 B. Surgical Care:
BBA........................ General Surgery............... 215.00 299.00 316.00 BBB........................ Cardiovascular and Thoracic 419.00 584.00 616.00 Surgery.
BBC........................ Neurosurgery................... 249.00 347.00 366.00 BBD........................ Ophthalmology................. 130.00 181.00 191.00 BBE........................ Organ Transplant.............. 1,106.00 1,541.00 1,625.00 BBF........................ Otolaryngology................ 149.00 207.00 219.00 BBG........................ Plastic Surgery............... 168.00 235.00 247.00 BBH........................ Proctology.................... 125.00 174.00 184.00 BBI........................ Urology....................... 164.00 228.00 240.00 BBJ........................ Pediatric Surgery............. 89.00 125.00 131.00 BBK........................ Peripheral Vascular Surgery... 98.00 137.00 145.00 BBL........................ Pain Management............... 138.00 193.00 203.00 BBM........................ Vascular and Interventional 493.00 687.00 724.00 Radiology.
C. Obstetrical and
Gynecological (OBGYN) Care:
BCA........................ Family Planning............... 76.00 106.00 111.00 [[Page 65027]]
BCB........................ Gynecology.................... 127.00 177.00 187.00 BCC........................ Obstetrics.................... 104.00 144.00 152.00 BCD........................ Breast Cancer Clinic........... 240.00 334.00 352.00 D. Pediatric Care:
BDA........................ Pediatric..................... 92.00 128.00 134.00 BDB........................ Adolescent.................... 83.00 115.00 121.00 BDC........................ Well Baby..................... 63.00 87.00 92.00 E. Orthopaedic Care:
BEA........................ Orthopaedic................... 143.00 200.00 211.00 BEB........................ Cast.......................... 89.00 123.00 130.00 BEC........................ Hand Surgery.................. 76.00 106.00 112.00 BEE........................ Orthotic Laboratory........... 93.00 130.00 137.00 BEF........................ Podiatry...................... 80.00 112.00 118.00 BEZ........................ Chiropractic.................. 38.00 53.00 55.00 F. Psychiatric and/or Mental Health Care:
BFA........................ Psychiatry..................... 165.00 230.00 242.00 BFB........................ Psychology.................... 115.00 160.00 169.00 BFC........................ Child Guidance................ 92.00 128.00 135.00 BFD........................ Mental Health................. 148.00 206.00 217.00 BFE........................ Social Work................... 147.00 205.00 217.00 BFF........................ Substance Abuse............... 141.00 197.00 208.00 G. Family Practice/Primary
Medical Care:
BGA........................ Family Practice............... 107.00 149.00 157.00 BHA........................ Primary Care.................. 109.00 151.00 160.00 BHB........................ Medical Examination........... 111.00 155.00 163.00 BHC........................ Optometry..................... 72.00 100.00 105.00 BHD........................ Audiology..................... 52.00 73.00 77.00 BHE........................ Speech Pathology.............. 122.00 170.00 180.00 BHF........................ Community Health.............. 85.00 118.00 125.00 BHG........................ Occupational Health........... 108.00 151.00 159.00 BHH........................ TRICARE Outpatient............ 74.00 104.00 109.00 BHI........................ Immediate Care................ 161.00 225.00 237.00 H. Emergency Medical Care:
BIA........................ Emergency Medical............. 173.00 242.00 255.00 I. Flight Medical Care:
BJA........................ Flight Medicine............... 124.00 173.00 182.00 J. Underseas Medical Care:
BKA........................ Underseas Medicine............ 77.00 108.00 114.00 K. Rehabilitative Services:
BLA........................ Physical Therapy.............. 56.00 79.00 83.00 BLB........................ Occupational Therapy.......... 75.00 104.00 110.00 III. Ambulatory Procedure Visit (APV) [Per visit \5\] Interagency and International other federal MEPRS code \4\ Clinical service military agency Other (full/ education and sponsored third party) training (IMET) patients Medical Care:
BB.......................... Surgical Care.................. $1,313.00 $1,829.00 $1,929.00 BE.......................... Orthopaedic Care............... 1,664.00 2,319.00 2,446.00 All Other................... B clinics other than BB and BE, 378.00 527.00 556.00 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 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.
[[Page 65028]]
IV. Other Rates and Charges \1\ \2\ Interagency and International other federal MEPRS code \4\ Clinical service military agency Other (full/ education and sponsored third party) training (IMET) patients A. Per Each:
FBI......................... Immunization................... $22.00 $31.00 $32.00 B. 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 ProviderPer
Procedure: \7\ \15\
DB.......................... Laboratory procedures requested 15.00 22.00 23.00 by an outside provider CPT '00 Weight Multiplier.
DC, DI...................... Radiology procedures requested 79.00 115.00 120.00 by an outside provider CPT '00 Weight Multiplier.
E. Dental RatePer Procedure:
\11\
Dental Services ADA code weight 73.00 112.00 117.00 multiplier.
F. Ambulance RatePer Hour:
\12\
FEA......................... Ambulance...................... 81.00 113.00 120.00 G. AirEvac RatePer Trip (24
hour period): \13\
AirEvac ServicesAmbulatory 339.00 473.00 499.00 AirEvac ServicesLitter....... 989.00 1,379.00 1,454.00 H. Observation RatePer hour
\14\
Observation ServicesHour..... 20.00 28.00 30.00 V. Elective Cosmetic Surgery Procedures and Rates International Current classification procedural Cosmetic surgery procedure diseases (ICD terminology FY 2001 Charge \9\ Amount of charge 9) (CPT) \8\ Mammaplastyaugmentation........... 85.50 19325 Inpatient Surgical (a) Care Per Diem or APV (b) 85.32 19324 85.31 19318 Mastopexy........................... 85.60 19316 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Facial.............................. 86.82 15824 Inpatient Surgical (a) Care Per Diem or APV (b) Rhytidectomy........................ 86.22
Blepharoplasty...................... 08.70 15820 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate 08.44 15821 15822 15823 Mentoplasty (Augmentation/or 76.68 21208 Inpatient Surgical (a) Reduction). Care Per Diem APV or (b) applicable Outpatient (c) Clinic Rate 76.67 21209 Abdominoplasty...................... 86.83 15831 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Lipectomy........................... 86.83 15876 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Suction per region 10............... 15877 15878 15879 Rhinoplasty......................... 21.87 30400 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate 21.86 30410 [[Page 65029]]
Scar Revisions beyond CHAMPUS....... 86.84 1578__ Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Mandibular or Maxillary 76.41 21194 Inpatient Surgical (a) Repositioning. Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Dermabrasion........................ 86.25 15780 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Hair Restoration.................... 86.64 15775 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Removing Tattoos.................... 86.25 15780 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Chemical Peel....................... 86.24 15790 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate Arm/Thigh: Dermolipectomy........... 86.83 15836/ Inpatient Surgical (a) Care Per Diem or APV (b) APV or applicable (b) Outpatient Clinic (c) Rate (e) Refractive surgery.................. ............... 15832 Radial Keratotomy................... ............... 65771

Other Procedure (if applies to ............... 66999 laser or other.

refractive surgery).............
Otoplasty........................... ............... 69300 APV or applicable (b) Outpatient Clinic (c) Rate Brow Lift........................... 86.3 15839 Inpatient Surgical (a) Care Per Diem or APV (b) or applicable (c) Outpatient Clinic Rate 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.AK. 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 NonActive 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 in \1\ 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
[[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 Code Outpatient 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) preprocedure and immediate postprocedure 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 MTFestablished 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 (see \4\ 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 DoDwide 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.AK. 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 x .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 inflight 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.
[[Page 65031]]
Attachment 1.Adjusted Standardized Amounts (ASA) By Military Treatment Facility Full cost Interagency IMET TPC DMISID MTF name Serv rate rate rate rate 0003................ Lyster AHFt. Rucker......... A.............. $6,637 $6,286 $3,286 $6,637 0004................ 502nd Med GrpMaxwell AFB.... F.............. 6,984 6,614 3,458 6,984 0005................ Bassett ACHFt. Wainwright... A.............. 7,152 6,774 3,541 7,152 0006................ 3rd Med GrpElmendorf AFB.... F.............. 7,041 6,668 3,486 7,041 0009................ 56th Med GrpLuke AFB........ F.............. 5,986 5,697 2,978 5,986 0014................ 60th Med GrpTravis AFB...... F.............. 9,912 9,387 4,907 9,912 0018................ 30th Med GrpVandenberg AFB.. F.............. 7,035 6,663 3,483 7,035 0019................ 95th Med GrpEdwards AFB..... F.............. 7,004 6,633 3,468 7,004 0024................ NH Camp Pendleton............. N.............. 7,614 7,245 3,787 7,614 0028................ NH Lemoore.................... N.............. 6,997 6,627 3,465 6,997 0029................ NH San Diego.................. N.............. 9,744 9,273 4,847 9,744 0030................ NH Twenty Nine Palms.......... N.............. 6,111 5,815 3,039 6,111 0032................ Evans ACHFt. Carson......... A.............. 6,946 6,578 3,439 6,946 0033................ 10th Med GrpUSAF Academy.... F.............. 6,994 6,623 3,463 6,994 0037................ Walter Reed AMC Washington A.............. 9,010 8,574 4,482 9,010 DC.
0038................ NH Pensacola.................. N.............. 8,939 8,465 4,426 8,939 0039................ NH Jacksonville............... N.............. 7,537 7,173 3,749 7,537 0042................ 96th Med GrpEglin AFB....... F.............. 8,309 7,869 4,114 8,309 0043................ 325th Med GrpTyndall AFB.... F.............. 7,002 6,631 3,467 7,002 0045................ 6th Med GrpMacDill AFB...... F.............. 5,991 5,702 2,980 5,991 0047................ Eisenhower AMCFt. Gordon.... A.............. 8,550 8,098 4,233 8,550 0048................ Martin ACHFt. Benning....... A.............. 7,987 7,564 3,954 7,987 0049................ Winn ACHFt. Stewart......... A.............. 6,644 6,292 3,289 6,644 0052................ Tripler AMCFt. Shafter...... A.............. 9,533 9,029 4,720 9,533 0053................ 366th Med GrpMountain Home F.............. 6,982 6,612 3,457 6,982 AFB.
0055................ 375th Med GrpScott AFB...... F.............. 7,625 7,256 3,793 7,625 0056................ NH Great Lakes................ N.............. 6,063 5,770 3,016 6,063 0057................ Irwin AHFt. Riley........... A.............. 6,521 6,176 3,229 6,521 0060................ Blanchfield ACHFt. Campbell. A.............. 6,605 6,255 3,270 6,605 0061................ Ireland ACHFt. Knox......... A.............. 6,829 6,467 3,381 6,829 0064................ BayneJones ACHFt. Polk..... A.............. 6,573 6,225 3,254 6,573 0066................ 89th Med GrpAndrews AFB..... F.............. 8,062 7,672 4,010 8,062 0067................ NNMC Bethesda................. N.............. 9,786 9,313 4,868 9,786 0073................ 81st Med GrpKeesler AFB..... F.............. 8,772 8,308 4,343 8,772 0075................ Wood ACHFt. Leonard Wood.... A.............. 6,539 6,193 3,237 6,539 0078................ 55th Med GrpOffutt AFB...... F.............. 8,697 8,236 4,306 8,697 0079................ 99th Med GrpNellis AFB...... F.............. 6,002 5,712 2,986 6,002 0083................ 377th Med GrpKirtland AFB... F.............. 6,971 6,602 3,452 6,971 0084................ 49th Med GrpHolloman AFB... F.............. 7,004 6,633 3,468 7,004 0086................ Keller ACHWest Point........ A.............. 7,296 6,909 3,612 7,296 0089................ Womack AMCFt. Bragg......... A.............. 7,817 7,403 3,870 7,817 0091................ NH Camp LeJeune............... N.............. 6,744 6,387 3,339 6,744 0092................ NH Cherry Point............... N.............. 6,788 6,429 3,361 6,788 0093................ 319th Med GrpGrand Forks F.............. 7,032 6,660 3,482 7,032 AFB.
0094................ 5th Med GrpMinot AFB........ F.............. 6,857 6,494 3,395 6,857 0095................ 74th Med GrpWright F............. 10,371 9,822 5,135 10,371 Patterson AFB.
0096................ 72nd Med GrpTinker AFB...... F.............. 6,001 5,711 2,985 6,001 0097................ 97th Med GrpAltus AFB....... F.............. 6,976 6,607 3,454 6,976 0098................ Reynolds ACHFt. Sill........ A.............. 6,831 6,469 3,382 6,831 0100................ NH Newport.................... N.............. 6,002 5,712 2,986 6,002 0101................ 20th Med GrpShaw AFB........ F.............. 6,964 6,595 3,448 6,964 0103................ NH Charleston................. N.............. 6,879 6,514 3,406 6,879 0104................ NH Beaufort................... N.............. 6,871 6,507 3,402 6,871 0105................ Moncrief ACHFt. Jackson..... A.............. 6,961 6,592 3,446 6,961 0106................ 28th Med GrpEllsworth AFB... F.............. 6,939 6,572 3,436 6,939 0108................ Wm Beaumont AMCFt. Bliss.... A.............. 8,329 7,888 4,124 8,329 0109................ Brooke AMCFt. Sam Houston.. A.............. 8,511 8,099 4,233 8,511 0110................ Darnall AHFt. Hood.......... A.............. 8,606 8,151 4,261 8,606 0112................ 7th Med GrpDyess AFB........ F.............. 6,892 6,528 3,413 6,892 0113................ 82nd Med GrpSheppard AFB.... F.............. 6,903 6,537 3,418 6,903 0117................ 59th Med WingLackland AFB... F.............. 8,640 8,222 4,297 8,640 0119................ 75th Med GrpHill AFB........ F.............. 5,983 5,693 2,976 5,983 0120................ 1st Med GrpLangley AFB...... F.............. 5,954 5,666 2,962 5,954 0121................ McDonald ACHFt. Eustis...... A.............. 5,649 5,376 2,810 5,649 0123................ Dewitt AHFt. Belvoir........ A.............. 8,237 7,839 4,097 8,237 0124................ NH Portsmouth................. N.............. 7,469 7,107 3,715 7,469 0125................ Madigan AMCFt. Lewis........ A.............. 11,018 10,435 5,455 11,018 0126................ NH Bremerton.................. N.............. 8,165 7,733 4,043 8,165 0127................ NH Oak Harbor................. N.............. 6,283 5,979 3,125 6,283 0129................ 90th Med GrpF.E. Warren AFB. F.............. 6,989 6,619 3,460 6,989 [[Page 65032]]
0131................ Weed ACHFt. Irwin........... A.............. 7,003 6,633 3,467 7,003 0449................ 24th Med GrpHoward.......... F.............. 9,489 9,045 3,872 9,489 0606................ 95th CSHHeidelberg.......... A.............. 9,489 9,045 3,872 9,489 0607................ Landstuhl Rgn MC.............. A.............. 9,489 9,045 3,872 9,489 0609................ 67th CSHWurzburg............ A.............. 9,489 9,045 3,872 9,489 0612................ 121st Gen HospSeoul......... A.............. 9,489 9,045 3,872 9,489 0615................ NH Guantanamo Bay............. N.............. 9,489 9,045 3,872 9,489 0616................ NH Roosevelt Roads............ N.............. 9,489 9,045 3,872 9,489 0617................ NH Naples..................... N.............. 9,489 9,045 3,872 9,489 0618................ NH Rota....................... N.............. 9,489 9,045 3,872 9,489 0620................ NH Guam....................... N.............. 9,489 9,045 3,872 9,489 0621................ NH Okinawa.................... N.............. 9,489 9,045 3,872 9,489 0622................ NH Yokosuka................... N.............. 9,489 9,045 3,872 9,489 0623................ NH Keflavik................... N.............. 9,489 9,045 3,872 9,489 0624................ BH Sigonella.................. N.............. 9,489 9,045 3,872 9,489 0633................ 48th Med GrpRAF Lakenheath.. F.............. 9,489 9,045 3,872 9,489 0635................ 39th Med GrpIncirlik AB..... F.............. 9,489 9,045 3,872 9,489 0638................ 51st Med GrpOsan AB......... F.............. 9,489 9,045 3,872 9,489 0639................ 35th Med GrpMisawa.......... F.............. 9,489 9,045 3,872 9,489 0640................ 374th Med GrpYokota AB...... F.............. 9,489 9,045 3,872 9,489 0805................ 52nd Med GrpSpangdahlem..... F.............. 9,489 9,045 3,872 9,489 0808................ 31st Med GrpAviano.......... 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. 0027726 Filed 103000; 8:45 am] BILLING CODE 311001P