Skip to main content

Military Health System

Sidebar Navigation

Ambulatory Surgery Rates

Generating APC Reimbursement Rates

To generate an APC reimbursement rate, please follow these steps:

  1. Use the Crosswalk of ZIP Code to MSA Code file to determine the MSA code for the subject ZIP Code.
  2. Use the ASC Payment Group Assignment file (from the ASCGR dropdown menu below) to determine the ASC Group for the subject CPT Code.
  3. Use the ASC Payment Group Rates by MSA file (from the ASCRT dropdown menu below) to determine the rate for the MSA Code from step 1 and the ASC Payment Group from step 2.

TRICARE-Approved Procedures for Freestanding Ambulatory Surgery Centers 

  • Effective November 1, 2016 to February 28, 2017.
  • Note: This file is no longer updated; for historical purposes only.

MSA Name 

  • Effective November 1, 2017.

National (not adjusted for MSA) Payment Rate by ASC Group (ASCNR)

  • Lines with termination date of "99999999" will always be the current rate.
  • Correction Date 00000000 means not applicable.
Download

ASC Payment Group Rates by MSA (ASCRT)

  • All variables right-adjusted.
Download

Crosswalk of ZIP Code to MSA Code

Crosswalk of ZIP Code to MSA Code

  • Sorted by state abbreviation, then ZIP Code.
  • ASC Payment Group Assignment (ASCGR)

    • Listed for each procedure code as a cumulative history file and sorted by CPT code.
    • The effective and termination dates refer to application of the group assignment.
    • Any multiple lines for a CPT code due to group changes will be in date order, oldest first.
    • Lines with termination date of "99999999" will always be the current group.
    Download
    Last Updated: November 21, 2022
    Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery