Pediatric-Specific and TRICARE-Designated New Technology Add-On Payment Updates
Monday, October 9, 2023
New Technology Add-On Payments (NTAP) allow hospitals to receive more appropriate reimbursement under the Centers for Medicare & Medicaid Services' (CMS) hospital Inpatient Prospective Payment System (IPPS) for new medical services and technology not yet included in Diagnosis-Related Group (DRG) rates. Recent updates to TRICARE’s NTAP policy add pediatric-specific NTAPs and TRICARE-designated NTAPs, retroactive to July 1, 2022.
Note: The reimbursement amounts in CMS' IPPS Final Rule represent the maximum add-on payment for each NTAP. CMS updates maximum NTAP payment amounts annually.
Pediatric-Specific NTAPs
TRICARE Reimbursement Manual (TRM), Chapter 6, Section 11 defines pediatrics as “patients under the age of 18, on date of admission, or any individual who is treated in a children's hospital or in a pediatric ward paid under the DRG reimbursement system.” Pediatric-specific NTAPs apply to hospital discharges on or after July 1, 2022.
For inpatient hospital claims, pediatric NTAPs may be applied when reimbursement is equal to the lesser of:
- 100% of the average cost of the technology, or
- 100% of the total covered costs that exceed the Medicare Severity-DRG payment.
TRICARE-Designated NTAPs
The Defense Health Agency establishes TRICARE-designated NTAPs for covered services and supplies for which CMS has not established an NTAP adjustment for DRGs. Technology manufacturers may submit a TRICARE NTAP application to request a new TRICARE-designated NTAP. Applications must be received by July 8 of the preceding fiscal year for which the TRICARE-specific NTAP is to be considered. Once available, we’ll post the application and submission instructions on our Forms page.
Requirements Overview
Per law and regulation, NTAPs are allowed until they are incorporated into the DRG, which can take between two and three years. For TRICARE-specific NTAP requirements, refer to TRM, Chapter 6, Section 11.
Claims
Per TRICARE policy, hospital claims for discharges on or after July 1, 2022, that were already processed by Health Net Federal Services, LLC (HNFS) will not automatically be adjusted. Providers may contact us via secure email (login required), fax, U.S. mail, or phone to request claims be reprocessed. Visit our DRG Reimbursement page for more information.
