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CMAC Rates

Please be advised that the presence of a CHAMPUS maximum allowable charge (CMAC) rate does not indicate coverage policy nor payment approval, but merely that a payment rate could be calculated for a CPT/HCPCS code based on Medicare data or TRICARE claims history.

Also be advised that the absence of a CMAC rate does not indicate coverage policy or payment denial.

Please consult the TRICARE Policy / Reimbursement Manuals to determine TRICARE benefits and coverage. To view the list of codes that are excluded from coverage and are not payable under the TRICARE program, visit the No Government Pay Procedure Code List.


NOTICE

There was an error in CMAC reimbursement lookups by ZIP Code in the new California Localities. Until further notice, please only initiate lookups for the following California Localities via the Locality drop down selector:

BAKERSFIELD
CHICO
EL_CENTRO
FRESNO
HANFORD
MADERA
MARIN
MERCED

MODESTO
NAPA
REDDING
RIVERSIDE/SAN_BERNARDINO
SACRAMENTO
SALINAS
SAN_BENITO_CNTY
SAN_DIEGO

SAN_LUIS_OBISPO
SANTA_CRUZ
SANTA_MARIA/BARBARA
SANTA_ROSA
STOCKTON
VALLEJO
VISALIA
YUBA_CITY

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