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UBO Rates Overview

The UBO billing rates are based on TRICARE allowable charges and are used to determine charges for outpatient, inpatient, dental, cosmetic surgery, and pharmacy services. Outpatient rates are the charges for professional and institutional health care services provided by MTFs. Inpatient rates are used when billing for inpatient medical services at MTFs. Each MTF providing inpatient care has its own applied Adjusted Standardized Amount (ASA). Pharmacy rates are based on TRICARE allowable charges, average wholesale price, or prime vendor program prices listed for the national drug codes and are used to set pharmacy rates for pharmaceuticals and approved drugs.

UBO rates differ slightly from the standard TRICARE rates. UBO rates are specifically formatted for military billing systems, and include charges for additional services not reimbursed by TRICARE.

The Assistant Secretary of Defense for Health Affairs (ASD/HA) approved the implementation of CY 2020 Outpatient Medical Dental and Cosmetic Procedure Reimbursement Rates for Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care received at military treatment facilities (MTFs) as on July 1, 2020. These rates are used to determine:

  • Charges for medical and dental services provided on an outpatient basis
  • Ambulatory services
  • Inpatient cosmetic surgery services

These rates were released in accordance with U.S.C. Title 10, and will remain in effect until further notice. 

The ASD/HA also approved the FY 2021 Inpatient Billing Rates for direct care received at MTFs effective October 1, 2020, and will remain in effect until further notice. These rates are used to determine charges for inpatient professional and institutional health care services provided in MTFs under the Defense Health Program (DHP). 

UBO rates are published online in accordance with Executive Order 13410 (August 2006) to promote health care transparency relating to quality and cost. 

Mapping Tables

UBO billing systems use rate files in conjunction with several mapping tables that direct the billing systems to the appropriate rate file for any given procedure. These mapping tables also specify the billing form for each procedure and provide appropriate revenue centers and modifiers for each procedure. The major mapping files include:

Calendar Year (CY)  Mapping Tables 

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