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MHS rates are used to determine charges for medical and dental services.
These files contain all localities and are compressed in a .zip file format. Please download the entire file before attempting to open.
CMAC Rates are adjusted for the locality of the providing military treatment facility. The following tables provide the key to determining which CMAC locality is appropriate for each MTF.
For CSE access, please contact your UBO Service Program Manager. A provider version is available upon request. Providers must email the UBO Help Desk to receive access credentials.
The DOD inpatient rates are approved and posted on the DOD Comptroller website. These rates are used when billing for inpatient medical services at MTFs.
A national number used to determine if a patient has exceeded the length of stay threshold for the Diagnosis Related Group assigned to the inpatient stay. When the LOS exceeds the threshold, additional charges apply.
- Calculation to determine additional charges per day: PDW x .33 x MTF Adjusted Standardized Amounts
- Calculation Per Diem Weight: DRG Relative Weighted Product/Geometric Mean LOS
- Calculation for total billed amount: (DRG RWP x MTF ASA) (PDW x .33 x #days in excess of LST x MTF ASA)
Pharmacy Rates are established on a unit measure price basis, and are standardized for NDCs within each generic sequence number. A GSN groups a set of NDCs with the same active ingredients, dosage form, and strength, regardless of vendor brand or generic description. Currently, rates are computed based on the median unit measure cost for all listed NDCs in each GSN group. The medium unit measure price is applied to all the NDCs in each GSN group.
As of January 2010, unit measure prices reflect the median TRICARE allowable ingredient costs.
- For the most accurate information on whether a specific drug requires prior authorization, please use the Formulary Search Tool.
- Before submitting claims to other health insurance carriers, MTFs should review the insurance carrier's website for its current list of pharmaceuticals requiring prior authorization.
Pharmacy Dispensing Fee
The total pharmacy charge is calculated by multiplying the number of units dispensed (e.g., the number of tablets or capsules) by the unit measure cost for the dispense NDC, available in the applicable pharmacy rate table, plus the dispensing fee.
Before July 2007, the dispensing fee covered non-ingredient costs, including overhead, supplies, and labor. Effective February 4, 2011, the dispensing fee was set to $2.00 per script dispensed. This cost mirrors the average allowable dispensing fee allowed under the TRICARE Retail Pharmacy Program.
The $2.00 dispensing fee remains in effect for FY21.
The billing rates below are for services provided at DOD deployed/non-fixed facilities to foreign nationals covered under Acquisition and Cross-Servicing Agreements and for services for patients other than foreign military personnel covered under ASCA.
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Last Updated: March 05, 2024