Inpatient Rates Increase Slightly for Fiscal Year 2004
Updated March 30, 2004
Oct 30, 2002
No. 02-29

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Effective Oct. 1, 2003, the daily cost of inpatient care in civilian hospitals for family members of active duty service members under TRICARE Standard and TRICARE Extra increased from $12.72 to $13.32 per day or $25, whichever is greater. For example, if a family member of an active duty service member is an inpatient for one day, he or she will pay $25. For inpatient stays that are two days or more, the cost will be $13.32 per day.

The TRICARE Standard diagnosis-related group (DRG) daily rate for most civilian non-mental health hospital admissions increased to $459, from $417 last year. The rate increase applies only to retirees, their families and survivors who use TRICARE Standard. They must either pay $459 per day, or a cost share of 25 percent of the hospital's billed charges, whichever is less. A 25 percent allowable charge for separately billed professional services could also apply. There is no DRG rate increase for beneficiaries who use a TRICARE network facility under TRICARE Extra.

Rates for inpatient mental health care or a substance-use disorder increased from $159 to $164 per day for retirees, their families and survivors who use TRICARE Standard. They also pay 25 percent of the allowable charge for separately billed professional services. The inpatient mental health rate is unchanged under TRICARE Prime and Extra for family members of active duty service members, military retirees, their families and survivors.

For additional information about DRG payments, interested parties may contact a customer service representative at the nearest TRICARE service center (TSC). A list of TSCs is available on the TRICARE Web site at http://www.tricare.osd.mil/tricarese...s/default.cfm. Beneficiaries also may contact the nearest beneficiary counseling and assistance coordinator (BCAC). A BCAC directory is available online at www.tricare.osd.mil/BCACDirectory.htm.