Skip Navigation

Defense Health Agency

"On October 1, 2013, the Department of Defense established the Defense Health Agency (DHA) to manage the activities of the Military Health System. These activities include those previously managed by TRICARE Management Activity (TMA), which was disestablished on the same date. During the next several months, all TMA websites will change to reflect the new DHA. We appreciate your patience during this transition."

Outpatient Prospective Payment System (OPPS)


TRICARE's OPPS was implemented on May 1, 2009

Note: To minimize download times, some of these documents are being supplied in zip format as well as unzipped. You must have file compression software on your computer in order to take advantage of the zipped format.


Quarterly Updates


Ambulatory Payment Classifications (APCs) with Status Indicators (SIs) and Payment Rates

   

Payment Status by HCPCS Code

   

Payment Status Indicators

   

Annual Updates


Maternity Diagnosis

   

OPPS Pricing Elements

   

Statewide Cost to Charge Ratios

   

Therapy Codes

   

Provider Information Updates


OPPS Provider File

   
       Provider Types contained in the OPPS provider file (click to expand)
       Provider Types (download)

Zip to Wage Index Crosswalk

   

Communication Articles



TRICARE Reimbursement Manual


       Reimbursement Manual (OPPS is contained in Chapter 13) (Link opens in new browser window.)


Applicable FARS/DFARS Restrictions Apply to Government Use