[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.................................................
----------------------------------------------------------------------------------------------------------------

1. FY2000 Direct Care Inpatient Reimbursement Rates

----------------------------------------------------------------------------------------------------------------
                                                                                                   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
----------------------------------------------------------------------------------------------------------------
                                                           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.
----------------------------------------------------------------------------------------------------------------


[[Page 61312]]


----------------------------------------------------------------------------------------------------------------
                                                            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
----------------------------------------------------------------------------------------------------------------


----------------------------------------------------------------------------------------------------------------
                                                                  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
----------------------------------------------------------------------------------------------------------------
* 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

----------------------------------------------------------------------------------------------------------------
                                                                   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
----------------------------------------------------------------------------------------------------------------
                                                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
----------------------------------------------------------------------------------------------------------------
                                 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
----------------------------------------------------------------------------------------------------------------
                                                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
----------------------------------------------------------------------------------------------------------------
                                               E. Orthopaedic Care
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------
                                    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
----------------------------------------------------------------------------------------------------------------
                                     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
----------------------------------------------------------------------------------------------------------------
                                            H. Emergency Medical Care
----------------------------------------------------------------------------------------------------------------
BIA...........................  Emergency Medical...............          126.00          234.00          247.00
----------------------------------------------------------------------------------------------------------------
                                             I. Flight Medical Care
----------------------------------------------------------------------------------------------------------------
BJA...........................  Flight Medicine.................           88.00          164.00          173.00
----------------------------------------------------------------------------------------------------------------
                                            J. Underseas Medical Care
----------------------------------------------------------------------------------------------------------------
BKA...........................  Underseas Medicine..............           43.00           79.00           84.00
----------------------------------------------------------------------------------------------------------------
                                            K. Rehabilitative Services
----------------------------------------------------------------------------------------------------------------
BLA...........................  Physical Therapy................           41.00           77.00           81.00
BLB...........................  Occupational Therapy............           61.00          114.00          120.00
----------------------------------------------------------------------------------------------------------------

III. Ambulatory Procedure Visit (APV) \6\ Per Visit

----------------------------------------------------------------------------------------------------------------
                                                                   International   Interagency &
                                                                     military      other federal
        MEPRS Code \4\                  Clinical service            education &       agency       Other (full/
                                                                     training        sponsored     third party)
                                                                      (IMET)         patients
----------------------------------------------------------------------------------------------------------------
  ............................            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).
----------------------------------------------------------------------------------------------------------------


[[Page 61314]]

IV. Other Rates and Charges 1 2 Per Visit

----------------------------------------------------------------------------------------------------------------
                                                                   International   Interagency &
                                                                     military      other federal
        MEPRS Code \4\                  Clinical service            education &       agency       Other (full/
                                                                     training        sponsored     third party)
                                                                      (IMET)         patients
----------------------------------------------------------------------------------------------------------------
FBI...........................  A. Immunization.................          $16.00          $30.00          $32.00
DGC...........................  B. Hyperbaric Chamber \5\.......          153.00          285.00          301.00
----------------------------------------------------------------------------------------------------------------

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

----------------------------------------------------------------------------------------------------------------
                                    International    Current procedural
   Cosmetic surgery procedure      classification     terminology (CPT)    FY 2000 charge \10\      Amount of
                                  diseases (ICD-9)           \9\                                      charge
----------------------------------------------------------------------------------------------------------------
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
----------------------------------------------------------------------------------------------------------------


[[Page 61315]]

G. Dental Rate \12\ Per Procedure

----------------------------------------------------------------------------------------------------------------
                                                                   International   Interagency &
                                                                     military      other federal
        MEPRS code \4\                  Clinical service            education &       agency       Other  (full/
                                                                     training        sponsored     third party)
                                                                      (IMET)         patients
----------------------------------------------------------------------------------------------------------------
                                Dental Services ADA code and DoD          $45.00         $109.00         $115.00
                                 established weight.
----------------------------------------------------------------------------------------------------------------

H. Ambulance Rate \13\ Per Visit

----------------------------------------------------------------------------------------------------------------
                                                                   International   Interagency &
                                                                     military      other federal
        MEPRS code \4\                  Clinical service            education &       agency       Other  (full/
                                                                     training        sponsored     third party)
                                                                      (IMET)         patients
----------------------------------------------------------------------------------------------------------------
FEA...........................  Ambulance.......................          $62.00         $116.00         $122.00
----------------------------------------------------------------------------------------------------------------

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

----------------------------------------------------------------------------------------------------------------
                                                                   International   Interagency &
                                                                     military      other federal
        MEPRS code \4\                  Clinical service            education &       agency       Other  (full/
                                                                     training        sponsored     third party)
                                                                      (IMET)         patients
----------------------------------------------------------------------------------------------------------------
                                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.
----------------------------------------------------------------------------------------------------------------

J. AirEvac Rate \14\ Per Visit

----------------------------------------------------------------------------------------------------------------
                                                                   International   Interagency &
                                                                     military      other federal
        MEPRS code \4\                  Clinical service            education &       agency       Other  (full/
                                                                     training        sponsored     third party)
                                                                      (IMET)         patients
----------------------------------------------------------------------------------------------------------------
                                AirEvac Services--Ambulatory....         $195.00         $364.00         $384.00
                                AirEvac Services--Litter........          567.00        1,056.00        1,114.00
----------------------------------------------------------------------------------------------------------------

K. Observation Rate \15\ Per hour

----------------------------------------------------------------------------------------------------------------
                                                                   International   Interagency &
                                                                     military      other federal
        MEPRS code \4\                  Clinical service            education &       agency       Other  (full/
                                                                     training        sponsored     third party)
                                                                      (IMET)         patients
----------------------------------------------------------------------------------------------------------------
                                Observation Services--Hour......          $17.00          $31.00          $32.00
----------------------------------------------------------------------------------------------------------------

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
------------------------------------------------------------------------

    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