[Federal Register Volume 61, Number 217 (Thursday, November 7, 1996)]
[Notices]
[Pages 57654-57659]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-28660]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF DEFENSE

Office of the Secretary


Medical and Dental Reimbursement Rates for Fiscal Year 1997

    Notice is hereby given that the Deputy Chief Financial Officer, in 
a memorandum dated September 19, 1996, established the following 
reimbursement rates for inpatient and outpatient medical care to be 
provided in FY 1997. These rates are effective October 1, 1996.

Inpatient, Outpatient and Other Rates and Charges

I. Inpatient Rates \1\ \2\

----------------------------------------------------------------------------------------------------------------
                                                                   International    Interagency                 
                                                                     military        and other                  
                        Per inpatient day                          education and  Federal agency       Other    
                                                                     training        sponsored                  
                                                                      (IMET)         patients                   
----------------------------------------------------------------------------------------------------------------
A. Burn Center..................................................       $2,107.00       $3,824.00       $4,086.00
B. Surgical Care Services (Cosmetic Surgery)....................          897.00        1,629.00        1,741.00
C. All Other Inpatient Services (Based on Diagnosis Related                                                     
 Groups (DRG) Charges \3\)                                                                                      
----------------------------------------------------------------------------------------------------------------

1. FY 1997 Direct Care Inpatient Reimbursement Rates

------------------------------------------------------------------------
                                                             Other (full/
     Adjusted standard amount          IMET     Interagency   3rd party)
------------------------------------------------------------------------
Large Urban......................       $2,154       $4,141       $4,392
Other Urban/Rural................        2,275        4,344        4,635
Overseas.........................        2,405        5,207        5,533
------------------------------------------------------------------------

2. Overview
    The FY 1997 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 costs 
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 outliers. The 
published ASAs will be adjusted for area wage differences and indirect 
medical education (IME) for the discharging hospital. An example of how 
to apply DoD costs to a DRG standardized weight to arrive at DoD costs 
is contained in section 1.C.3, below.
3. Example of Adjusted Standardized Amounts for Inpatient Stays
    Figure 1 shows an example for a nonteaching hospital in a large 
urban area.
    a. The cost to be recovered is DoD's cost for medical services 
provided in the nonteaching hospital located in a large urban area. 
Billings will be at third party rate.
    b. DRG 020: Nervous System Infection Except Viral Meningitis. The 
RWP for an inlier case is the CHAMPUS weight of 2.9769. (DRG statistics 
shown are from FY 1996.)
    c. The DoD Adjusted Standardized Amount to be charged is $4,392 
(the third party rate as shown in paragraph I.C.1).
    d. DoD costs to be recovered at a nonteaching hospital with area 
wage index of 1.0 is the RWP factor in item b, above, times the amount 
in item c (2.9769 x $4,392).
    e. Cost to be recovered is $13,075.

                                     Figure 1.--Third Party Billing Example                                     
----------------------------------------------------------------------------------------------------------------
                                                               Arithmetic   Geometric    Short stay   Long stay 
         DRG No.              DRG description     DRG weight    mean LOS     mean LOS    threshold    threshold 
----------------------------------------------------------------------------------------------------------------
020......................  Nervous System             2,9769         11.2          7.8            1           30
                            Infection Except                                                                    
                            Viral Meningitis.                                                                   
----------------------------------------------------------------------------------------------------------------


                                                                                                                
                                                               Area wage       IME                              
           Hospital                       Location             rate index   adjustment   Group ASA   Applied ASA
Nonteaching Hospital.........  Large Urban..................          1.0          1.0       $4,392       $4,392
----------------------------------------------------------------------------------------------------------------


                                                                                                                                                        
                                                                                                            Relative weighted product                   
                Patient No.                                Length of stay                 Days above ---------------------------------------  TPC amount
                                                                                          threshold    Inlier \1\  Outlier \2\     Total         \3\    
1..........................................  7 days....................................            0       2.9769       0.0000       2.9769      $13,075
2..........................................  21 days...................................            0       2.9769       0.0000       2.9769       13,075

[[Page 57655]]

                                                                                                                                                        
3..........................................  35 days...................................            5       2.9769       0.8397       3.8166       16,763
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ DRG weight.                                                                                                                                         
\2\ Outlier calculation=44 percent of per diem weight multiplied by the number of outlier days:                                                         
  =.44 x (DRG Weight/Geometric Mean LOS) x (Patient LOS Long Stay Threshold).                                                                           
  =.44 x (2.9769/7.8) x (35-30).                                                                                                                        
  =.44 x (.38165) x 5 (take out to 5 decimal places).                                                                                                   
  =.16793 x 5 (take out to 5 decimal places).                                                                                                           
  =.8397 (take out to 4 decimal places).                                                                                                                
\3\ Applied ASA x Total RWP.                                                                                                                            

II. Outpatients Rates \1\ \2\

----------------------------------------------------------------------------------------------------------------
                                                                                        Interagency             
                                                                         International   and other              
                                                                            military      Federal               
        MEPRS  code \4\                Per visit clinical services       education and     agency       Other   
                                                                            training     sponsored              
                                                                             (IMET)       patients              
----------------------------------------------------------------------------------------------------------------
                                                 A. Medical Care                                                
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BAA............................  Internal Medicine.....................           $92          $167         $178
BAB............................  Allergy...............................            34            61           66
BAC............................  Cardiology............................            61           111          119
BAE............................  Diabetes..............................            57           103          110
BAF............................  Endocrinology.........................            71           130          139
BAG............................  Gastroenterology......................            89           162          173
BAH............................  Hematology............................            89           162          173
BAI............................  Hypertension..........................            60           108          116
BAJ............................  Nephrology............................           114           207          221
BAK............................  Neurology.............................            86           156          167
BAL............................  Nutrition.............................            24            43           46
BAM............................  Oncology..............................            81           148          158
BAN............................  Pulmonary Disease.....................            97           175          187
BAO............................  Rheumatology..........................            73           133          142
BAP............................  Dermatology...........................            54            98          105
BAQ............................  Infectious Disease....................            76           139          148
BAR............................  Physical Medicine.....................            73           132          141
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                                B. Surgical Care                                                
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BBA............................  General Surgery.......................           107           193          207
BBB............................  Cardiovascular/Thoracic Surgery.......            92           167          178
BBC............................  Neurosurgery..........................           108           197          210
BBD............................  Ophthalmology.........................            72           131          140
BBE............................  Organ Transplant......................           109           199          212
BBF............................  Otolaryngology........................            83           150          160
BBG............................  Plastic Surgery.......................            87           158          169
BBH............................  Proctology............................            63           114          122
BBI............................  Urology...............................            93           169          180
BBJ............................  Pediatric Surgery.....................            53            97          103
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                    C. Obstetrical and Gynecological (OB-GYN)                                   
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BCA............................  Family Planning.......................            59           108          115
BCB............................  Gynecology............................            67           121          129
BCC............................  Obstetrics............................            63           114          121
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                                D. Pediatric Care                                               
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BDA............................  Pediatric.............................            51            93          100
BDB............................  Adolescent............................            49            89           95
BDC............................  Well Baby.............................            30            54           58
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                               E. Orthopaedic Care                                              
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BEA............................  Orthopaedic...........................            74           135          144
BEB............................  Cast Clinic...........................            34            63           67
BEC............................  Hand Surgery..........................            37            67           72
BEE............................  Orthopaedic Appliance.................            53            95          102
BEF............................  Podiatry..............................            44            80           86

[[Page 57656]]

                                                                                                                
BEZ............................  Chiropractic Clinic...................            24            44           47
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                    F. Psychiatric and/or Mental Health Care                                    
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BFA............................  Psychiatry............................            79           144          154
BFB............................  Psychology............................            75           137          146
BFC............................  Child Guidance........................            46            83           89
BFD............................  Mental Health.........................            71           129          138
BFE............................  Social Work...........................            60           109          117
BFF............................  Substance Abuse Rehabilitation........            60           110          117
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                             G. Primary Medical Care                                            
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BGA............................  Family Practice.......................            58           106          113
BHA............................  Primary Care..........................            56           102          109
BHB............................  Medical Examination...................            50            91           97
BHC............................  Optometry.............................            37            68           73
BHD............................  Audiology Clinic......................            27            48           52
BHE............................  Speech Pathology......................            60           108          116
BHF............................  Community Health......................            39            70           75
BHG............................  Occupational Health...................            51            92           98
BHI............................  Immediate Care Clinic.................            75           137          146
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                            H. Emergency Medical Care                                           
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BIA............................  Emergency Care Clinic.................            91           164          176
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                            I. Flight Medicine Clinic                                           
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BJA............................  Flight Medicine.......................            85           154          164
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                           J. Underseas Medicine Care                                           
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BKA............................  Underseas Medicine Clinic.............            26            46           50
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                           K. Rehabilitative Services                                           
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BLA............................  Physical Therapy......................            24            44           47
BLB............................  Occupational Therapy..................            32            58           62
BLC............................  Neuromuscularskeletal Screening.......            20            37           39
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                          L. Ambulatory Procedure Visit                                         
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                                                                  413           746          797
----------------------------------------------------------------------------------------------------------------

III. Other Rates and Charges

----------------------------------------------------------------------------------------------------------------
                                                                                        Interagency             
                                                                         International   and other              
                                                                            military      Federal               
        MEPRS  code \4\                Per visit clinical service        education and     agency       Other   
                                                                            training     sponsored              
                                                                             (IMET)       patients              
----------------------------------------------------------------------------------------------------------------
FBI............................  A. Immunizations......................         $8.00        $15.00       $16.00
DGC............................  B. Hyperbaric Services \5\ (per hour).        110.00        201.00       214.00
                                 C. Family Member Rate (formerly                 9.90                           
                                  Military Dependents Rate).                                                    
----------------------------------------------------------------------------------------------------------------

D. Reimbursement Rates for High Cost Drugs Requested by External 
Providers \6\
    The FY 1997 high cost drug reimbursement rates are for 
prescriptions requested by external providers and obtained at the 
military treatment facility. The high cost drug reimbursement rates are 
too numerous to include in this notice. A complete listing of these 
rates is available on request from OASD (Health Affairs), LCDR Pat 
Kelly, (703) 681-8910.

[[Page 57657]]

E. Reimbursement Rates for High Cost Services Requested by External 
Providers \7\
    The FY 1997 high cost services requested by external providers and 
obtained at the military treatment facility are too numerous to include 
in this notice. A complete listing of these rates is available on 
request from OASD (Health Affairs), LCDR Pat Kelly, (703) 681-8910.
F. Elective Cosmetic Surgery Procedures and Rates

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                  International    Current                                                                              
                                                 classification   procedural                                                                  Amount of 
           Cosmetic surgery procedure            diseases (ICD-  terminology                         FY 97 charge \9\                           charge  
                                                       9)         (CPT) \8\                                                                             
--------------------------------------------------------------------------------------------------------------------------------------------------------
Mammaplasty....................................          85.50         19325  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                         85.32         19324                                                                         (b)
                                                         85.31         19318                                                                            
Mastopexy......................................          85.60         19316  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Facial.........................................          86.82         15824  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
Rhytidectomy...................................          86.22                                                                                       (b)
Blepharoplasty.................................          08.70         15820  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                         08.44         15821                                                                         (b)
                                                                       15822                                                                            
                                                                       15823                                                                            
Mentoplasty (Augmentation/Reduction)...........          76.68         21208  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                         76.67         21209                                                                         (b)
Abdominoplasty.................................          86.83         15831  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Lipectomy, Suction per Region \10\.............          86.83         15876  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                       15877                                                                         (b)
                                                                       15878                                                                            
                                                                       15879                                                                            
Rhinoplasty....................................          21.87         30400  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                         21.86         30410                                                                         (b)
Scar Revisions beyond CHAMPUS..................          86.84        1578__  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Mandibular or Maxillary Repositioning..........          76.41         21194  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Minor Skin Lesions \11\........................          86.30        1578__  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Dermabrasion...................................          86.25         15780  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Hair Restoration...............................          86.64         15775  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Removing Tattoos...............................          86.25         15780  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Chemical Peel..................................          86.24         15790  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Arm/Thigh Dermolipectomy.......................          86.83        1583__  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
Brow Lift......................................          86.3          15839  Surgical Care Services or Ambulatory Procedure Visit.........          (a)
                                                                                                                                                     (b)
--------------------------------------------------------------------------------------------------------------------------------------------------------

G. Dental Rate

----------------------------------------------------------------------------------------------------------------
                                                                                        Interagency             
                                                                         International   and other              
                                                                            military      Federal               
        MEPRS  code \4\              Per visit clinical service \12\     education and     agency       Other   
                                                                            training     sponsored              
                                                                             (IMET)       patients              
----------------------------------------------------------------------------------------------------------------
CA.............................  Dental Services (CTV 1)...............         $9.00        $25.00       $26.00
CA.............................  Dental Services (CTV 2)...............          7.00         20.00        21.00
CB.............................  Dental Prosthetics Laboratory (CLV)...          2.00          6.00         6.00
----------------------------------------------------------------------------------------------------------------

H. Ambulance Rate \13\

----------------------------------------------------------------------------------------------------------------
                                                                                        Interagency             
                                                                         International    & other               
                                                                            Military      Federal               
        MEPRS  code \4\                Per visit clinical service        Education and     agency       Other   
                                                                            Training     sponsored              
                                                                             (IMET)       patients              
----------------------------------------------------------------------------------------------------------------
FEA............................  Ambulance Service.....................        $57.00       $103.00      $110.00
----------------------------------------------------------------------------------------------------------------


[[Page 57658]]

I. High Cost Laboratory and Radiology Service \7\

----------------------------------------------------------------------------------------------------------------
                                                                                        Interagency             
                                                                         International    & other               
                                                                            Military      Federal               
        MEPRS  code \4\                Per visit clinical service        Education and     agency       Other   
                                                                            Training     sponsored              
                                                                             (IMET)       patients              
----------------------------------------------------------------------------------------------------------------
                                 High cost laboratory CPT-4 multiplier.         $6.00        $10.00       $11.00
                                 High cost radiology CPT-4 multiplier..         20.00         36.00        38.00
----------------------------------------------------------------------------------------------------------------

J. AirEvac Rate\14\

----------------------------------------------------------------------------------------------------------------
                                                                  International      Interagency and            
                                         Per visit clinical    Military Education     other Federal             
            MEPRS code\4\                     service             and Training      agency sponsored     Other  
                                                                     (IMET)             patients                
----------------------------------------------------------------------------------------------------------------
                                      AirEvac Services                     $89.00             $162.00    $173.00
                                       (Ambulatory).                                                            
                                      AirEvac Services                     265.00              481.00     513.00
                                       (Litter).                                                                
----------------------------------------------------------------------------------------------------------------

Notes on Cosmetic Surgery Charges

    a Charges for inpatient Surgical Care Services are 
contained in Section I.B. (See Notes 9 through 11 on reimbursable 
rates for further details.)
    b Charges for Ambulatory Procedure Visits (formerly Same 
Day Surgery) are contained in Section II.L. (See Notes 9 through 11 
on reimbursable rates for further details.)

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 fee. The outpatient per visit percentages are 58 
percent hospital, 30 percent ancillary and 12 percent professional.
    2 DoD civilian employees located in overseas areas shall be 
rendered a bill when services are performed. Payment is due 60 days 
from the date of the bill.
    3 The cost per DRG (Diagnosis Related Groups) 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 will be comparable 
to procedures utilized by 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.
    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. An example of this hierarchical arrangement is as follows:

------------------------------------------------------------------------
   Outpatient care (functional category)             MEPRS code         
------------------------------------------------------------------------
Medical Care (Summary Account)............  BA                          
Internal Medicine (Subaccount)............  BAA                         
------------------------------------------------------------------------

MEPRS codes are used to ensure that consistent expense and operating 
performance data is reported in the DoD military medical system.
    5 Hyperbaric services are to be charged based on full hours 
and 15 minute increments of service. Providers should calculate the 
charges based on the number of hours (or fraction thereof) of 
service. Fractions of hours should be rounded to the next 15 minute 
increment (e.g. 31 minutes becomes 45 minutes).
    6 High cost prescription services requested by external 
providers (Physicians, Dentists, etc.) are relevant to the Third 
Party Collection Program. Third party payers (such as insurance 
companies) shall be billed for high cost prescriptions in those 
instances in which beneficiaries who have medical insurance, seen by 
providers external to a Military Medical Treatment Facility (MTF), 
obtain the prescribed medication from an MTF. Eligible beneficiaries 
(family members or retirees with medical insurance) are not 
personally liable 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 come to the MTF for 
prescription services. A bill will be produced if the total 
prescription costs in a day (defined as 0001 hours to 2400 hours) 
exceeds $25.00 when bundled together. Bundling refers to the 
accumulation of a patient's bills during the previously defined 24 
hour period. The standard cost of high cost medications includes the 
cost of the drugs plus a dispensing fee, per prescription. The 
prescription cost is calculated by multiplying the number of units 
(tablets, capsules, etc.) times the unit cost and adding a $5.00 
dispensing fee per prescription.
    \7\ Charges for high cost ancillary services requested by 
external providers (Physicians, Dentists, etc.) are relevant to the 
Third Party Collection Program. Third party payers (such as 
insurance companies) shall be billed for high cost services in those 
instances in which beneficiaries who have medical insurance, are 
seen by providers external to an MTF, and obtain the prescribed 
service from an MTF. Laboratory and Radiology procedure costs are 
calculated using the CPT-4 weight multiplied by either the high cost 
laboratory or radiology multiplier (Section III.I). 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 come to the MTF for high cost 
services. A bill will be produced if the total ancillary services 
costs in a day (defined as 0001 hours to 2400 hours) exceed $25.00 
when bundled together. Bundling refers to the accumulation of a 
patient's bill during the previously defined 24 hour period.
    \8\ The attending physician is to complete the Physicians' 
Current Procedural Terminology code to indicate the appropriate 
procedure followed during cosmetic surgery. The appropriate rate 
will be applied depending on the admission type of the patient, 
e.g., ambulatory procedure visit or inpatient surgical care 
services.
    \9\ Family members of active duty personnel, retirees and their 
family members, and survivors will be charged cosmetic surgery 
rates. The patient shall be charged the rate as specified in the FY 
1997 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 Surgical Care Services in 
Section I.B., or Ambulatory Procedure Visits as contained in Section 
II.L of this attachment. The patient will be responsible for both 
the cost of the implant(s) in addition to the prescribed cosmetic 
surgery rates.

[[Page 57659]]

    Note: The implants and procedures used for the augmentation 
mammaplasty are in compliance with Federal Drug Administration 
guidelines.
    \10\ Each regional lipectomy will carry a separate charge. 
Regions include head and neck, abdomen, flanks, and hips.
    \11\ These procedures are inclusive in the minor skin lesions. 
However, CHAMPUS separates them as noted here. All charges are for 
the entire treatment regardless of the number of visits required.
    \12\ Dental services are based on a Composite Time Value (CTV). 
Charges should be calculated based on the time value of the 
procedure times the CTV rate. The first CTV (1.0 value) shall be 
calculated using the CTV 1 rate. Any subsequent CTVs and portions 
thereof shall be calculated using the CTV 2 rate. The Composite Lab 
Value (CLV) should be used to calculate charges for dental 
appliances and prostheses.
    \13\ Ambulance charges are based on full hours and 15 minute 
increments of service. Providers should calculate the charges based 
on the number of hours (or fraction thereof) that the ambulance is 
logged out on a patient run. Fractions of hours should be rounded to 
the next 15 minute increment (e.g. 31 minutes becomes 45 minutes).
    \14\ Air in-flight medical care reimbursement charges are 
determined by the status of the patient (Litter or Ambulatory) and 
are per patient.

    Dated: November 4, 1996.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 96-28660 Filed 11-6-96, 8:45 am]
BILLING CODE 5000-04-M