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Ambulatory Surgery Center Reimbursement Update on Oct. 1

Thursday, September 14, 2023

Effective for service dates on or after Oct. 1, 2023, TRICARE is adopting the Centers for Medicare and Medicaid Services’ (CMS) ambulatory surgery center (ASC) reimbursement system for freestanding ASCs. You can find complete details about this change in the TRICARE Reimbursement Manual Chapter 9, Section 2, at https://manuals.health.mil/.  

Locating reimbursement rates:

Freestanding ASCs will be reimbursed the lesser of CMS’ ASC payment rate (or your negotiated rate with HNFS, if applicable) or billed charges. Note: HNFS may pend claims while we update our systems to reflect this change. 

For surgical procedures covered under TRICARE, but not Medicare, HNFS can reimburse the rendering provider for related professional services. We will not issue a separate payment for facility charges. 

Find additional information about ASC benefits and reimbursement on our web page.