Ambulatory Surgery Center Reimbursement Update on Oct. 1

Thursday, September 14, 2023

Effective for service dates on or after Oct. 1, 2023, TRICARE is adopting the Centers for Medicare and Medicaid Services’ (CMS) ambulatory surgery center (ASC) reimbursement system for freestanding ASCs. You can find complete details about this change in the TRICARE Reimbursement Manual Chapter 9, Section 2, at https://manuals.health.mil/.  

Locating reimbursement rates:

• For services rendered on or after Oct. 1, 2023: Find payment rates for ASC-covered surgical procedures and ancillary services at https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc. Health Net Federal Services, LLC (HNFS) will implement any future updates to these rates within 21 days of publication on CMS’ website.   
  
  
• For services rendered prior to Oct. 1, 2023: Refer to the rate schedule posted on TRICARE’s “Ambulatory Surgery Rates” page at www.health.mil/rates. 

Freestanding ASCs will be reimbursed the lesser of CMS’ ASC payment rate (or your negotiated rate with HNFS, if applicable) or billed charges. Note: HNFS may pend claims while we update our systems to reflect this change. 

For surgical procedures covered under TRICARE, but not Medicare, HNFS can reimburse the rendering provider for related professional services. We will not issue a separate payment for facility charges. 

Find additional information about ASC benefits and reimbursement on our web page.