Cancer and Children's Hospital Billing
TRICARE uses the Outpatient Prospective Payment System (OPPS) to pay claims filed for hospital-based outpatient services. While the TRICARE OPPS closely mirrors Medicare’s OPPS method, there are some necessary differences to accommodate the uniqueness of the TRICARE program.
Outpatient services provided by cancer and children's hospital are subject to OPPS for service dates on or after Oct. 1, 2023. You can look up OPPS reimbursement rates at https://health.mil/rates.
Find complete details in the TRICARE Reimbursement Manual (TRM), Chapter 13.
