Federal Register, Volume 64 Issue 217 (Wednesday, November 10, 1999)

[Federal Register Volume 64, Number 217 (Wednesday, November 10, 1999)]
[Notices]
[Pages 61311-61316]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-29392]

[[Page 61311]]

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DEPARTMENT OF DEFENSE

Office of the Secretary

Medical and Dental Services for Fiscal Year 2000

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SUMMARY: Notice is hereby given that on September 30, 1999, the Deputy
Chief Financial Officer approved the following reimbursement rates for
inpatient and outpatient medical care to be provided in FY 2000. These
rates are effective October 1, 1999.

Medical and Dental Services for Fiscal Year 2000

The FY 2000 Department of Defense (DoD) reimbursement rates for
inpatient, outpatient, and other services are provided in accordance
with Title 10, United States Code, Section 1095. Due to size, the
sections containing the Drug Reimbursement Rates (Section III.E) and
the rates for Ancillary Services Requested by Outside Providers
(Section III.F) are not included in this package. The Office of the
Assistant Secretary of Defense (Health Affairs) will provide these
rates upon request (MAJ Rose Layman, OASD(HA)--Response Management/Tri-
Care Management Activity, (703) 681-8910 or DSN 761-8910). The medical
and dental service rates in this package (including the rates for
ancillary services, prescription drugs or other procedures requested by
outside providers) are effective October 1, 1999.

Inpatient, Outpatient and Other Rates and Charges

I. Inpatient Rates ^{1 2}

----------------------------------------------------------------------------------------------------------------
International
Interagency Interagency &
military other federal Other (full/
Per inpatient day education & agency third party)
training sponsored
(IMET) patients
----------------------------------------------------------------------------------------------------------------
A. Burn Center.................................................. $3,080.00 $5,529.00 $5,840.00
B. Surgical Care Services (Cosmetic Surgery).................... 1,411.00 2,533.00 2,675.00
C. All Other Inpatient Services (Based on Diagnosis Related
Groups (DRG) ³.................................................
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1. FY2000 Direct Care Inpatient Reimbursement Rates

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Other (full/
Standard amount IMET Interagency third party)
----------------------------------------------------------------------------------------------------------------
Large Urban..................................................... $2,921.00 $5,498.00 $5,775.00
Other Urban/Rural............................................... 3,236.00 6,532.00 6,883.00
Overseas........................................................ 3,606.00 8,520.00 8,941.00
----------------------------------------------------------------------------------------------------------------

2. Overview
The FY2000 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.
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 paragraph I.C.3., below.
3. Example of Adjusted Standardized Amounts for Inpatient Stays
Figure 1 shows examples 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 non-teaching hospital located in a large urban area.
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 2.3446. (DRG statistics
shown are from FY 1998.)
c. The DoD adjusted standardized amount to be charged is $5,775
(i.e., the third party rate as shown in the table).
d. DoD cost to be recovered at a nonteaching hospital with area
wage index of 1.0 is the RWP factor (2.3446) in subparagraph 3.b.,
above, multiplied by the amount ($5,775) in subparagraph 3.c., above.
e. Cost to be recovered is $13,540.

Figure 1.--Third Party Billing Examples
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Arithmetic Geometric Short stay Long stay
DRG No. DRG description DRG weight mean LOS mean LOS threshold threshold
----------------------------------------------------------------------------------------------------------------
020.............. Nervous System 2.3446 8.1 5.7 1 29
Infection Except Viral
Meningitis.
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[[Page 61312]]

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Area wage IME
Hospital Location rate index adjustment Group ASA Applied ASA
Non-teaching Hospital............. Large Urban......... 1.0 1.0 $5,775 $5,775
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----------------------------------------------------------------------------------------------------------------
Relative weighted product
Patient Length of stay Days above ------------------------------------------ TPC Amount
threshold Inlier * Outlier ** Total ***
#1................. 7 days............... 0 2.3446 0.0000 2.3446 $13,540
#2................. 21 days.............. 0 2.3446 0.0000 2.3446 13,540
#3................. 35 days.............. 6 2.3446 0.8144 3.1590 18,243
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* DRG Weight
** Outlier calculation = 33 percent of per diem weight x number of outlier days
= .33 (DRG Weight/Geometric Mean LOS) x (Patient LOS-Long Stay Threshold)
= .33 (2.3446/5.7) x (35-29)
= .33 (.41133) x 6 (take out to five decimal places)
= .13574 x 6 (carry to five decimal places)
= .8144 (carry to four decimal places)
*** Applied ASA x Total RWP

II. Outpatient Rates \1\ \2\ Per Visit

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International Interagency
military and other
MEPRS code \4\ Clinical service education & federal agency Other (full/
training sponsored third party)
(IMET) patients
----------------------------------------------------------------------------------------------------------------
A. Medical Care
----------------------------------------------------------------------------------------------------------------
BAA........................... Internal Medicine............... $104.00 $194.00 $204.00
BAB........................... Allergy......................... 53.00 99.00 105.00
BAC........................... Cardiology...................... 87.00 163.00 172.00
BAE........................... Diabetic........................ 61.00 114.00 121.00
BAF........................... Endocrinology (Metabolism)...... 102.00 190.00 201.00
BAG........................... Gastroenterology................ 146.00 272.00 287.00
BAH........................... Hematology...................... 179.00 334.00 352.00
BAI........................... Hypertension.................... 106.00 198.00 208.00
BAJ........................... Nephrology...................... 208.00 387.00 409.00
BAK........................... Neurology....................... 121.00 225.00 238.00
BAL........................... Outpatient Nutrition............ 42.00 79.00 83.00
BAM........................... Oncology........................ 134.00 250.00 264.00
BAN........................... Pulmonary Disease............... 153.00 285.00 301.00
BAO........................... Rheumatology.................... 101.00 188.00 199.00
BAP........................... Dermatology..................... 78.00 146.00 154.00
BAQ........................... Infectious Disease.............. 178.00 332.00 350.00
BAR........................... Physical Medicine............... 83.00 155.00 163.00
BAS........................... Radiation Therapy............... 128.00 238.00 251.00
BAT........................... Bone Marrow Transplant.......... 115.00 214.00 226.00
BAU........................... Genetic......................... 367.00 683.00 721.00
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B. Surgical Care
----------------------------------------------------------------------------------------------------------------
BBA........................... General Surgery................. 148.00 276.00 291.00
BBB........................... Cardiovascular and Thoracic 320.00 595.00 628.00
Surgery.
BBC........................... Neurosurgery.................... 173.00 323.00 341.00
BBD........................... Ophthalmology................... 90.00 168.00 177.00
BBE........................... Organ Transplant................ 399.00 742.00 783.00
BBF........................... Otolaryngology.................. 106.00 197.00 207.00
BBG........................... Plastic Surgery................. 131.00 244.00 258.00
BBH........................... Proctology...................... 84.00 157.00 165.00
BBI........................... Urology......................... 112.00 209.00 221.00
BBJ........................... Pediatric Surgery............... 167.00 311.00 328.00
BBK........................... Peripheral Vascular Surgery..... 78.00 146.00 154.00
BBL........................... Pain Management................. 97.00 180.00 190.00
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C. Obstetrical and Gynecological (OB-GYN) Care
----------------------------------------------------------------------------------------------------------------
BCA........................... Family Planning................. 57.00 106.00 112.00
BCB........................... Gynecology...................... 89.00 165.00 175.00
BCC........................... Obstetrics...................... 74.00 138.00 146.00
BCD........................... Breast Cancer Clinic............ 184.00 342.00 361.00
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D. Pediatric Care
----------------------------------------------------------------------------------------------------------------
BDA........................... Pediatric....................... 62.00 115.00 121.00

[[Page 61313]]

BDB........................... Adolescent...................... 65.00 122.00 129.00
BDC........................... Well Baby....................... 42.00 79.00 83.00
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E. Orthopaedic Care
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BEA........................... Orthopaedic..................... 93.00 174.00 183.00
BEB........................... Cast............................ 59.00 110.00 117.00
BEC........................... Hand Surgery.................... 69.00 129.00 136.00
BEE........................... Orthotic Laboratory............. 67.00 125.00 132.00
BEF........................... Podiatry........................ 56.00 105.00 111.00
BEZ........................... Chiropractic.................... 25.00 47.00 50.00
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F. Psychiatric and/or Mental Health Care
----------------------------------------------------------------------------------------------------------------
BFA........................... Psychiatry...................... 124.00 230.00 243.00
BFB........................... Psychology...................... 93.00 174.00 184.00
BFC........................... Child Guidance.................. 57.00 105.00 111.00
BFD........................... Mental Health................... 104.00 194.00 204.00
BFE........................... Social Work..................... 102.00 190.00 200.00
BFF........................... Substance Abuse................. 99.00 184.00 195.00
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G. Family Practice/Primary Medical Care
----------------------------------------------------------------------------------------------------------------
BGA........................... Family Practice................. 74.00 138.00 146.00
BHA........................... Primary Care.................... 77.00 143.00 151.00
BHB........................... Medical Examination............. 80.00 148.00 156.00
BHC........................... Optometry....................... 50.00 93.00 98.00
BHD........................... Audiology....................... 35.00 65.00 69.00
BHE........................... Speech Pathology................ 101.00 188.00 199.00
BHF........................... Community Health................ 66.00 123.00 130.00
BHG........................... Occupational Health............. 73.00 136.00 143.00
BHH........................... TRICARE Outpatient.............. 56.00 104.00 109.00
BHI........................... Immediate Care.................. 107.00 200.00 211.00
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H. Emergency Medical Care
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BIA........................... Emergency Medical............... 126.00 234.00 247.00
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I. Flight Medical Care
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BJA........................... Flight Medicine................. 88.00 164.00 173.00
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J. Underseas Medical Care
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BKA........................... Underseas Medicine.............. 43.00 79.00 84.00
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K. Rehabilitative Services
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BLA........................... Physical Therapy................ 41.00 77.00 81.00
BLB........................... Occupational Therapy............ 61.00 114.00 120.00
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III. Ambulatory Procedure Visit (APV) \6\ Per Visit

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International Interagency &
military other federal
MEPRS Code \4\ Clinical service education & agency Other (full/
training sponsored third party)
(IMET) patients
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............................ Medical Care
BB............................ Surgical Care................... 937.00 1,740.00 1,836.00
BD............................ Pediatric Care.................. 233.00 430.00 454.00
BE............................ Orthopaedic Care................ 1,179.00 2,192.00 2,313.00
All other B clinics not included 430.00 797.00 841.00
above (BA, BC, BF, BG, BH, BI,
BJ, BK and BL).
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[[Page 61314]]

IV. Other Rates and Charges ^{1 2} Per Visit

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International Interagency &
military other federal
MEPRS Code \4\ Clinical service education & agency Other (full/
training sponsored third party)
(IMET) patients
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FBI........................... A. Immunization................. $16.00 $30.00 $32.00
DGC........................... B. Hyperbaric Chamber \5\....... 153.00 285.00 301.00
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C. Family Member Rate $10.85 (formerly Military Dependents Rate)
D. Reimbursement Rates For Drugs Requested By Outside Providers \7\
The FY 2000 drug reimbursement rates for drugs are for
prescriptions requested by outside providers and obtained at a Military
Treatment Facility. The rates are established based on the cost of the
particular drugs provided based on the DoD-wide average per National
Drug Code (NDC) number. Final rule 32 CFR Part 220, which was not
published at the time that this package was prepared, eliminates the
dollar threshold for high cost ancillary services and the associated
term ``high cost ancillary service.'' The phrase ``high cost ancillary
service'' will be replaced with the phrase ``ancillary services
requested by an outside provider'' on publication of final rule 32 CFR
Part 220. The list of drug reimbursement rates is too large to include
in this document. Those rates are available on request from OASD
(Health Affairs)--Resource Management/TMA, Attention: Major Rose
Layman, telephone: (703) 681-8910.
E. Reimbursement Rates for Ancillary Services Requested By Outside
Providers \8\
Final rule 32 CFR Part 220, which was not published at the time
that this package was prepared, eliminates the dollar threshold for
high cost ancillary services and the associated term ``high cost
ancillary service.'' The phrase ``high cost ancillary service'' will be
replaced with the phrase ``ancillary services requested by an outside
provider'' on publication of final rule 32 CFR Part 220. The list of FY
2000 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 on request from OASD (Health
Affairs)--Resource Management/TMA, Attention: Major Rose Layman,
telephone: (703) 681-8910.
F. Elective Cosmetic Surgery Procedures and Rates

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International Current procedural
Cosmetic surgery procedure classification terminology (CPT) FY 2000 charge \10\ Amount of
diseases (ICD-9) \9\ charge
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Mammaplasty--augmentation...... 85.50, 85.32, 19325 19324, 19318 Inpatient Surgical (^a ^b)
85.31. Care Per Diem Or APV
Mastopexy...................... 85.60............. 19316............. Inpatient Surgical (^a ^b ^c)
Care Per Diem Or APV
or applicable
Outpatient Clinic
Rate
Facial Rhytidectomy............ 86.82, 86.22...... 15824............. Inpatient Surgical (^a ^b)
Care Per Diem Or APV
Blepharoplasty................. 08.70, 08.44...... 15820, 15821, Inpatient Surgical (^a ^b ^c)
15822, 15823. Care Per Diem Or APV
or applicable
Outpatient Clinic
Rate
Mentoplasty (Augmentation/ 76.68, 76.67...... 21208, 21209...... Inpatient Surgical (^a ^b ^c)
Reduction). Care Per Diem Or APV
or applicable
Outpatient Clinic
Rate
Abdominoplasty................. 86.83............. .................. Inpatient Surgical (^a)
Care Per Diem
Lipectomy Suction per region 11 86.83............. 15876, 15877, Inpatient Surgical (^a ^b ^c)
15878, 15879. Care Per Diem Or APV
or applicable
Outpatient Clinic
Rate
Rhinoplasty.................... 21.87, 21.86...... 30400, 30410...... Inpatient Surgical (^a ^b ^c)
Care Per Diem Or APV
or applicable
Outpatient Clinic
Rate
Scar Revisions beyond CHAMPUS.. 86.84............. 1578--............ Inpatient Surgical (^a ^b ^c)
Care Per Diem Or APV
or applicable
Outpatient Clinic
Rate
Mandibular or Maxillary 76.41............. .................. Inpatient Surgical (^a)
Repositioning. Care Per Diem
Dermabrasion................... .................. 15780............. APV or applicable (^b ^c)
Outpatient Clinic
Rate
Hair Restoration............... .................. 15775 APV or applicable (^b ^c)
Outpatient Clinic
Rate.
Removing Tattoos............... .................. 15780............. APV or applicable (^b ^c)
Outpatient Clinic
Rate
Chemical Peel.................. .................. 15790............. APV or applicable (^b ^c)
Outpatient Clinic
Rate
Arm/Thigh Dermolipectomy....... 86.83............. 15836, 15832...... Inpatient Surgical (^a ^b)
Care Per Diem Or APV
Refractive surgery............. .................. .................. APV or applicable (^b ^c)
Outpatient Clinic
Rate
Radial Keratotomy.......... .................. 65771............. ...................... ...............
Other Procedure (if applies .................. 66999............. ...................... ...............
to laser or other
refractive surgery).
Otoplasty...................... .................. 69300............. APV or applicable (^a ^b ^c)
Outpatient Clinic
Rate
Brow Lift...................... 86.3.............. 15839............. Inpatient Surgical (^a ^b)
Care Per Diem Or APV
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[[Page 61315]]

G. Dental Rate \12\ Per Procedure

H. Ambulance Rate \13\ Per Visit

I. Ancillary Services Requested by an Outside Provider \8\ Per
Procedure

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International Interagency &
military other federal
MEPRS code \4\ Clinical service education & agency Other (full/
training sponsored third party)
(IMET) patients
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Laboratory procedures requested $13.00 $20.00 $21.00
by an outside provider CPT `99
weight multiplier.
Radiology procedures requested 57.00 86.00 90.00
by an outside provider CPT `99
weight multiplier.
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J. AirEvac Rate \14\ Per Visit

K. Observation Rate \15\ Per hour

Notes on Cosmetic Surgery Charges

^a Per diem charges for inpatient surgical care
services are listed in section I.B. (See notes 9 through 11, below,
for further details on reimbursable rates.)
^b Charges for ambulatory procedure visits (formerly
same day surgery) are listed in section III.C. (See notes 9 through
11, below, for further details on reimbursable rates.) The
ambulatory procedure visit (APV) rate is used if the elective
cosmetic surgery is performed in an ambulatory procedure unit (APU).
^c Charges for outpatient clinic visits are listed in
sections II.A-K. The outpatient clinic rate is not used for services
provided in an APU. The APV rate should be used in these cases.

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.
⁴ The Medical Expense and Performance Reporting
System (MEPRS) code is a three digit code which defines the summary
account and the subaccount within a functional category in the DoD
medical system. MEPRS codes are used to ensure that consistent
expense and operating performance data is reported in the DoD
military medical system. An example of the MEPRS hierarchical
arrangement follows:

------------------------------------------------------------------------
MEPRS Code
------------------------------------------------------------------------
Outpatient Care (Functional Category)...... B
Medical Care (Summary Account)........... BA

[[Page 61316]]

Internal Medicine (Subaccount)......... BAA
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⁵ Hyperbaric service charges shall be based on hours
of service in 15-minute increments. The rates listed in section
III.B. 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) of service. Fractions of an hour shall be rounded to the
next 15-minute increment (e.g., 31 minutes shall be charged as 45
minutes).
⁶ Ambulatory procedure visit is defined in DOD
Instruction 6025.8, ``Ambulatory Procedure Visit (APV),'' dated
September 23, 1996, as immediate (day of procedure) pre-procedure
and immediate post-procedure care requiring an unusual degree of
intensity and provided in an ambulatory procedure unit (APU). An APU
is a location or organization within an MTF (or freestanding
outpatient clinic) that is specially equipped, staffed and
designated for the purpose of providing the intensive level of care
associated with APVs. Care is required in the facility for less than
24 hours. All expenses and workload are assigned to the MTF-
established APU associated with the referring clinic. The BB, BD 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, BD or
BE.
⁷ Prescription services requested by outside
providers (e.g., physicians and dentists) that are relevant to the
Third Party Collection Program. 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. 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 that includes the cost of the drugs plus a dispensing fee
per prescription. The prescription cost is calculated by multiplying
the number of units (e.g., tablets or capsules) by the unit cost and
adding a $6.00 dispensing fee per prescription. Final rule 32 CFR
Part 220, which was not published at the time that this package was
prepared, eliminates the dollar threshold for high cost ancillary
services and the associated term ``high cost ancillary service.''
The phrase ``high cost ancillary service'' will be replaced with the
phrase ``ancillary services requested by an outside provider'' on
publication of final rule 32 CFR Part 220. The elimination of the
threshold also eliminates 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.
\8\ 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 99) code by either the laboratory or radiology
multiplier (section III.J). 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. Final rule 32 CFR Part
220, which was not published at the time that this package was
prepared, eliminates the dollar threshold for high cost ancillary
services and the associated term ``high cost ancillary service.''
The phrase ``high cost ancillary service'' will be replaced with the
phrase ``ancillary services requested by an outside provider'' on
publication of final rule 32 CFR Part 220. The elimination of the
threshold also eliminates 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.
\9\ The attending physician is to complete the CPT 99 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.
\10\ 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 III.G. The patient shall be charged the rate as
specified in the FY 2000 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.C, or the appropriate
outpatient clinic rate in sections II.A-K. The patient is
responsible for the cost of the implant(s) and the prescribed
cosmetic surgery rate. (Note: The implants and procedures used for
the augmentation mammaplasty are in compliance with Federal Drug
Administration guidelines.)
\11\ Each regional lipectomy shall carry a separate charge.
Regions include head and neck, abdomen, flanks, and hips.
\12\ Dental service rates are based on a dental rate multiplier
times the American Dental Association (ADA) code and the DoD
established weight for that code.
\13\ Ambulance charges shall be based on hours of service in 15-
minute increments. The rates listed in section III.I 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).
\14\ Air in-flight medical care reimbursement charges are
determined by the status of the patient (ambulatory or litter) and
are per patient. 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 using the commercial rate
effective the date of travel plus $1.00.
\15\ Observation Services are billed at the hourly charge. Begin
counting when the patient is placed in the observation bed and round
up to the nearest hour. 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.

Dated: November 4, 1999.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 99-29392 Filed 11-9-99; 8:45 am]
BILLING CODE 5001-10-P