TRICARE changes its reimbursement policies in the final rule aligning with Medicare reimbursement methodology: Favorable to interventional pain management

Effective, October 1, 2023, TRICARE is adopting the Medicare reimbursement methodology for Ambulatory Surgery Centers (ASCs). Adoption of Medicare’s ASC reimbursement system will bring TRICARE reimbursement for ambulatory surgery care into alignment with the statutory requirement that payment methods for institutional care be, to the extent practicable, in accordance with the same reimbursement rules used by Medicare.

Changes to the TRICARE Reimbursement Manual 6010.58-M, April 1, 2015 edition, Change 72 (August 7, 2023), Chapter 9, Ambulatory Surgery Centers (ASCs), can be found at this here.

• Reference Section 2, Ambulatory Surgical Center (ASC) Reimbursement For Service On Or After October 1, 2023
• 0 POLICY
• 1  Effective for service dates on or after October 1, 2023, TRICARE is adopting the Medicare ASC reimbursement system including their ASC fee schedule rules, payment rates, payment indicators, list of covered procedures and ancillary services, and wage indices.

Please see Section 2 for a full description of the applicable changes. This change will create TRICARE and Medicare Fee-For-Service ASC reimbursement parity for all authorized ASC procedures. Consequently, access to care in the ASC setting for TRICARE beneficiaries will improve because of this change.