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Diagnosis-Related Group Rates

This page serves as a central repository for rates within the TRICARE/CHAMPUS DRG-Based Payment System. Use the dropdowns below to view current and historical data related to DRG-Based Payments.

Based on the Final Rule [84 FR 4333] that published on February 15, 2019, the TRICARE DRG effective date will be delayed to January 1, for FY20 and beyond. See 32 CFR 199.14, (a)(1)(i)(D) DRG system updates. The CHAMPUS DRG-based payment system is modeled on the Medicare Prospective Payment System (PPS) and uses annually updated items and numbers from the Medicare PPS as provided for in this part and in instructions issued by the Director, DHA. The effective date of these items and numbers shall not correspond to that under Medicare PPS but shall be delayed until January 1, to align with TRICARE's program year reporting. This allows for an administrative simplicity that optimizes healthcare delivery by reducing existing administrative burden and costs.

Please be advised that TRICARE Reimbursement Manual (TRM) Chapter 6 Section 7, Hospital Reimbursement - TRICARE Diagnosis Related Group (DRG)-Based Payment System (Adjusted Standardized Amounts (ASAs)), Paragraph 3.2.7, Labor-Related and Non-Labor-Related Portions of the ASA, lists incorrect labor and non-labor related portions of the ASA. For Calendar Year 2024, for wage index values greater than 1.0, the labor related portion of the ASA is 67.6%, and the non-labor related portion is 32.4%. The correct values are incorporated in the information on this web page. TRM Chapter 6 Section 7 Paragraph 3.2.7 is in the process of being corrected.

TRICARE/CHAMPUS Adjusted Standardized Amounts (ASAs) & DRG Weights Summary

DRG Payment Calculator

This calculator is used as an estimating tool only. The values given in this calculator are approximate, and may not reflect actual reimbursement. Actual reimbursement will vary by claim based on the authoritative guidance found in the TRICARE Reimbursement manual. For questions or more information about rates, policies, etc., please contact your managed care support contractor. To learn more about DRG Rates, please visit the TRICARE Reimbursement Manual, Chapter 6.

Wage Indexes and IDME Factors

DRG Update Summaries

Hospital-Acquired Conditions (HAC)

TRICARE has adopted the same Hospital-Acquired Conditions as CMS.

Other Information

Last Updated: June 27, 2024
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