Generating APC Reimbursement Rates
To generate an APC reimbursement rate, please follow these steps:
- Use the Crosswalk of ZIP Code to MSA Code file to determine the MSA code for the subject ZIP Code.
- Use the ASC Payment Group Assignment file (from the ASCGR dropdown menu below) to determine the ASC Group for the subject CPT Code.
- Use the ASC Payment Group Rates by MSA file (from the ASCRT dropdown menu below) to determine the rate for the MSA Code from step 1 and the ASC Payment Group from step 2.
TRICARE-Approved Procedures for Freestanding Ambulatory Surgery Centers
- Effective November 1, 2016 to February 28, 2017.
- Note: This file is no longer updated; for historical purposes only.
MSA Name
- Effective November 1, 2017.
National (not adjusted for MSA) Payment Rate by ASC Group (ASCNR)
- Lines with termination date of "99999999" will always be the current rate.
- Correction Date 00000000 means not applicable.
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ASC Payment Group Rates by MSA (ASCRT)
- All variables right-adjusted.
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Crosswalk of ZIP Code to MSA Code
ASC Payment Group Assignment (ASCGR)
- Listed for each procedure code as a cumulative history file and sorted by CPT code.
- The effective and termination dates refer to application of the group assignment.
- Any multiple lines for a CPT code due to group changes will be in date order, oldest first.
- Lines with termination date of "99999999" will always be the current group.
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Last Updated: April 06, 2023