TriWest Healthcare Alliance has updated the reimbursement schedule for codes that do not have an established CHAMPUS Maximum Allowable Charge (CMAC) reimbursement rate. This includes recent updates to S9088 and 90378 (see links to files below).
CMAC rates are established by the TRICARE Management Activity (TMA) for various codes and are used by TriWest where established. However, not all codes have established CMAC rates. For codes that do not have a CMAC rate, TriWest developed reimbursement amounts based on Medicare rates, state prevailing rates or other proprietary methodologies.
This reimbursement schedule allows providers to know in advance what the reimbursement rates for codes without CMAC values will be and helps to ensure that TriWest applies consistent pricing. If CMAC rates are subsequently established for any codes on this reimbursement schedule which had previously been set by TriWest, the new CMAC rate will supersede and govern the reimbursement for these services. TriWest will update the reimbursement schedule as necessary.
For further information or questions, call 1-888-TRIWEST (1-888-874-9378).
State Prevailing Fee Schedule Effective 10/1/07 (posted 06/02/08)
State Prevailing Fee Schedule Effective 3/1/07 (posted 12/15/06)
State Prevailing Fee Schedule Effective 10/1/06 (Updated 12/15/06)
State Prevailing Fee Schedule Effective 4/1/2006-9/30/06 (Updated 12/15/06)
State Prevailing Fee Schedule Effective 11/10/2005-3/31/2006 (Updated 12/15/06)
S9088 Updates Effective 10/1/04 (posted 10/20/06)
