[Federal Register Volume 59, Number 145 (Friday, July 29, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-18061]
[[Page Unknown]]
[Federal Register: July 29, 1994]
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OFFICE OF MANAGEMENT AND BUDGET
Cost of Hospital and Medical Care and Treatment Furnished by the
United States; Certain Rates Regarding Recovery From Tortiously Liable
Third Persons
By virtue of the authority vested in the President by Section 2(a)
of P.L. 87-693 (76 Stat. 593; 42 U.S.C. 2652), and delegated to the
Director of the Office of Management and Budget by Executive Order No.
11541 of July 1, 1970 (35 FR 10737), the revised set of Department of
Defense rates outlined below are hereby established. These rates are
for use in connection with the recovery, from tortiously liable third
persons, of the cost of hospital and medical care treatment furnished
by the United States (Part 43, Chapter I, Title 28, Code of Federal
Regulations) through three separate Federal agencies. The rates have
been established in accordance with the requirements of OMB Circular A-
25, requiring reimbursement of the full cost of all services provided.
The rates are established as follows:
Department of Defense. Historic costs including purchases of
supplies and equipment, base pay, allowances, permanent change of
station costs, retirement pay and health benefits accrual costs,
medical specialty pays and medical training are determined. These costs
are then adjusted to reflect civilian and military pay raises and
inflation to arrive at the estimated rates. An asset charge is included
to reflect depreciation.
For the period beginning April 1, 1994, the rates herein superseded
those established by the Director of the Office of Management and
Budget on October 1, 1992 (57 CFR 48642).
Leon E. Panetta,
Director, Office of Management and Budget.
Tortiously Liable Rates, Fiscal Year 1994, April 1994 Through September
1994--Inpatient, Outpatient and Other Rates and Charges
------------------------------------------------------------------------
Full
reimbursement
rate
------------------------------------------------------------------------
I. Per Inpatient Day:
A. Burn Center....................................... $2,975
B. Inpatient Other Than Burn Center\1\
Medical Care Services............................ 783
Surgical Care Services........................... 1,082
Obstetrical and Gynecological Care............... 1,020
Pediatric Care................................... 785
Orthopedic Care.................................. 977
Psychiatric Care and Substance Abuse............. 479
Medical Intensive Care and Coronary Care......... 1,703
Surgical Intensive Care.......................... 1,855
Neonatal Intensive Care.......................... 1,087
Organ and Bone Marrow Transplant................. 1,533
Same Day Surgery................................. 426
II. Per Outpatient Visit:\2\
A. Medical Treatment Facilities...................... 101
B. PRIMUS/NAVCARE.................................... \3\61
III. Other Rates and Charges:
A. Hyperbaric Services:
1-60 minutes..................................... 177
61-120 minutes................................... 345
121-180 minutes.................................. 512
181-240 minutes.................................. 679
------------------------------------------------------------------------
(Note: Charges may be prorated based on usage.)
----------------------------------------------------------------------------------------------------------------
Total dispensed Standard
Generic (trade) name Strength quantity\4\ cost
----------------------------------------------------------------------------------------------------------------
B. High Cost Medications Requested By External
Providers:\3\
Acyclovir (Zovirax).................................... 800mg............... 100............. $286
Acyclovir oint......................................... 15g................. 6 Tubes......... 161
Aminoglutethamide (Cytadren)........................... 250mg............... 360............. 376
Amiodarone (Cardarone)................................. 200mg............... 180............. 218
Amlodipine (Norvasc)................................... 2.5mg............... 270............. 248
Amlodipine (Norvasc)................................... 5mg................. 270............. 252
Astemizole (Hismanal).................................. 50mg................ 90.............. 109
Auranofin (Ridaura).................................... 3mg................. 180............. 153
Betoxolol (Betoptic)................................... .25%................ 3 btls.......... 114
Bromocriptine.......................................... 2.5mg............... 270............. 454
Buspirone (Buspar)..................................... 5mg................. 270............. 121
Buspirone (Buspar)..................................... 10mg................ 270............. 208
Calcitonin (Calcimar).................................. 200 IU.............. 8 vials......... 179
Captopril (Capoten).................................... 25mg................ 270............. 134
Captopril (Capoten).................................... 50mg................ 270............. 221
Captopril (Capoten).................................... 100mg............... 270............. 333
Carbenicillin.......................................... 382mg............... 40.............. 103
Caridopa/Levodopa CR (Sinemet CR)...................... .................... 270............. 291
Caridopa/Levodopa (Sinemet 25/100)..................... 25/100.............. 360............. 184
Caridopa/Levodopa (Sinemet 25/250)..................... 25/250.............. 360............. 235
Chemstrip BG II........................................ .................... 360............. 271
Cholestyramine powder.................................. .................... 6 cans.......... 151
Cholestyramine powder light............................ .................... 6 cans.......... 129
Cimetidine............................................. 400mg............... 180............. 146
Cimetidine............................................. 300mg............... 360............. 164
Cimetidine syrup....................................... .................... 3 btls.......... 150
Clemastine (Tavist).................................... 2.68mg.............. 270............. 183
Clomipramine (Anafranil)............................... 50mg................ 360............. 292
Clomipramine (Anafranil)............................... 25mg................ 360............. 210
Colestipol............................................. 5mg packets......... 360 pkt......... 274
Cromolyn inhaler....................................... .................... 4 btls.......... 183
Cromolyn soln (nebulizer).............................. .................... 360 amp......... 204
Cyclophosphamide....................................... 25mg................ 360............. 360
Cyclophosphamide....................................... 50mg................ 360............. 681
Cyclosporine........................................... 100mg............... 60.............. 257
Cyclosporine........................................... 100mg/ml sol........ 3 btls.......... 639
Danazol (Danocrine).................................... 200mg............... 180............. 320
Demeclocycline......................................... 150mg............... 60.............. 145
Desmopressin nasal soln (DDAVP)........................ .................... 20 ml........... 367
Desmopressin nasal spray............................... .................... 20 ml........... 328
Diclofenac (Voltaren).................................. 75mg................ 180............. 150
Diclofenac (Voltaren).................................. 50mg................ 270............. 187
Didanosine............................................. 150mg............... 180............. 357
Didanosine (Videx)..................................... 25mg................ 360............. 124
Didanosine (Videx)..................................... 100mg............... 360............. 475
Diflucan............................................... 100mg............... 30.............. 182
Diflucan............................................... 200mg............... 30.............. 298
Diflunisal (Dolobid)................................... 500mg............... 180............. 173
Diltiazem 60mg (Cardizem).............................. 60mg................ 270............. 130
Diltiazem CD (Cardizem CD)............................. 240mg............... 90.............. 135
Diltiazem CD (Cardizem CD)............................. 300mg............... 90.............. 174
Diltiazem SR........................................... 120mg............... 180............. 144
Diltiazem SR........................................... 60mg................ 180............. 111
Diltiazem (Cardizem)................................... 120mg............... 360............. 315
Divalproax (Depakote).................................. 250mg............... 360............. 146
Elase ointment......................................... .................... 6 tubes......... 157
Enalapril.............................................. 5mg................. 180............. 127
Enalapril.............................................. 20mg................ 180............. 190
Enalapril.............................................. 10mg................ 180............. 134
Epoetin Alfa 2000...................................... .................... 24.............. 478
Epoetin Alfa 3000...................................... .................... 24.............. 727
Epoetin Alfa 4000...................................... .................... 24.............. 979
Estramustine (Emcyt)................................... 150mg............... 150............. 361
Ethambutol............................................. 400mg............... 180............. 177
Ethosuximide........................................... 250mg............... 360............. 167
Etidronate Disodium.................................... 400mg............... 90.............. 164
Etidronate Disodium (Didronel.......................... 200mg............... 270............. 492
Etoposide (VePesid).................................... 50mg................ 25.............. 619
Exactech............................................... .................... 90 days......... 450
Famotidine (Pepcid).................................... 20mg................ 180............. 152
Fentanyl patch......................................... 100mcg.............. 10.............. 245
Fentanyl patch......................................... 75mcg............... 10.............. 203
Fluconazole (Diflucan)................................. 200mg............... 30.............. 298
Fluconazole (Diflucan)................................. 100mg............... 30.............. 182
Fluconazole (Diflucan)................................. 50mg................ 30.............. 116
Fluoxetine (Prozac).................................... 20mg................ 60.............. 102
Flurbiprofen (Ansaid).................................. 100mg............... 90.............. 150
Flutamide (Eulexin).................................... 125mg............... 540............. 597
Gemfibrozil (Lopid).................................... 600mg............... 180............. 160
Glipizide.............................................. 10mg................ 180............. 177
Hemofil M.............................................. .................... 30 days......... 6,816
Hydroxychloroquine..................................... 200mg............... 180............. 178
Hydroxyurea (Hydrea)................................... 500mg............... 270............. 308
Interferon (Intron A).................................. 3mu................. 12.............. 287
Isotretinoin (Accutane)................................ 10mg................ 60.............. 133
Isotretinoin (Accutane)................................ 20mg................ 60.............. 158
Isotretinoin (Accutane)................................ 40mg................ 60.............. 182
Itraconazole (Sporonox)................................ 10mg................ 30.............. 127
Leucovorin............................................. 5mg................. 100............. 166
Leuprolide (Lupron).................................... 7.5mg............... 1............... 387
Leuprolide (Lupron).................................... 3.75mg.............. 1............... 278
Lisinopril............................................. 10mg................ 180............. 112
Lisinopril (Prinivil).................................. 5mg................. 180............. 112
Lomustine.............................................. 40mg................ 20.............. 182
Lomustine.............................................. 100mg............... 20.............. 400
Lovastatin (Mevacor)................................... 20mg................ 180............. 265
Lovastatin (Mevacor)................................... 40mg................ 180............. 492
Loxapine (Loxitane).................................... 50mg................ 180............. 138
Lypressin spray (Diapid)............................... .................... 4 btls.......... 116
Megestrol (Megace)..................................... 20mg................ 360............. 120
Megestrol (Megace)..................................... 40mg................ 360............. 228
Melphalan (Alkeran).................................... 2mg................. 350............. 410
Mesalamine enema (Rowasa).............................. 500mg............... 90.............. 158
Metaproterenol neb soln................................ 0.6%................ 100............. 105
Methazolamide.......................................... 50mg................ 270............. 166
Methotrexate........................................... 2.5mg............... 180............. 170
Methysergide Maleate................................... 2mg................. 180............. 182
Mexiletine (Mexitil)................................... 200mg............... 270............. 156
Mexiletine (Mexitil)................................... 250mg............... 270............. 185
Mexiletine (Mexitil)................................... 150mg............... 270............. 131
Misoprostol............................................ 200mcg.............. 360............. 197
Naproxen............................................... 500mg............... 180............. 176
Naproxen............................................... 375mg............... 270............. 216
Naproxen............................................... 250mg............... 270............. 168
Nicotine Transdermal System............................ 21mg................ 30.............. 100
Nifedipine............................................. 60mg XL............. 90.............. 151
Nifedipine............................................. 90mg XL............. 90.............. 181
Nortriptyline HCL...................................... 25mg................ 90.............. 107
Olsalazine (Dipentim).................................. 250mg............... 360............. 149
Omperazole (Prilosec).................................. 20mg................ 90.............. 268
One Touch Test Strips.................................. .................... 360............. 171
Pancrelipase MT16...................................... .................... 540............. 313
Pancrelipase (Pancrease)............................... .................... 540............. 119
Penicillamine.......................................... 250mg............... 360............. 260
Perphenazine........................................... 2mg................. 360............. 11
Pravastin Sodium (Pravachol)........................... 10mg................ 90.............. 125
Pravastin Sodium (Pravachol)........................... 20mg................ 90.............. 132
Probucol (Lorelco)..................................... 250mg............... 360............. 184
Procarbazine (Matulane)................................ 50mg................ 360............. 204
Procyclidine (Kemadrin)................................ 5mg................. 360............. 113
Pyrazinamide........................................... 500mg............... 360............. 430
Ranitidine............................................. 150mg............... 180............. 152
Rifampin with INH...................................... .................... 180............. 493
Selegeline (Eldepryl).................................. 5mg................. 180............. 416
Somatrem (Protropin)................................... 5mg................. 4............... 770
Somatropin (Humatrope)................................. .................... 6 Vials......... 1,126
Sucalfate (Carafate)................................... 1GM................. 360............. 183
Sulindac............................................... 150mg............... 360............. 112
Sulindac............................................... 200mg............... 360............. 139
Tamoxifen (Nolvadex)................................... 10mg................ 180............. 207
Terfenadine (Seldane).................................. .................... 180............. 124
Ticlopidine (Ticlid)................................... 250mg............... 180............. 219
Tocainide (Tonocard)................................... 400mg............... 270............. 181
Tocainide (Tonocard)................................... 600mg............... 270............. 231
Tracer BG Strips....................................... .................... 360............. 252
Ursidiol (Actigall).................................... 300mg............... 90.............. 145
Verapamil SR 240 (Calan SR)............................ .................... 180............. 100
Zalcitabine (Hivid).................................... .75mg............... 270............. 542
Zidovudine (Retrovir).................................. 100mg............... 450............. 598
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------------------------------------------------------------------------
Cost of
Service provided service
------------------------------------------------------------------------
C. High Cost Services Requested By External Providers:\3\
X-Ray Ribs (all), per side............................. $114
X-Ray Hips, Bilateral.................................. 116
Upper Gastrointestinal (G.I.) study with contrast...... 146
Hysterosalpingogram.................................... 128
Mammogram, Bilateral or with localization.............. 131
Ultrasound, per study.................................. 117
Ultrasound--complete abdomen or with biopsy............ 203
Computerized Axial Tomography (CAT) scan head/brain
without contrast...................................... 198
Computerized Axial Tomography (CAT) scan head/brain
with contrast......................................... 223
Computerized Axial Tomography (CAT) scan head/brain
with and without contrast, or post fossa and IAM/IACS. 315
Computerized Axial Tomography (CAT) scan chest......... 348
Computerized Axial Tomography (CAT) scan abdomen, per
study................................................. 172
Computerized Axial Tomography (CAT) scan extremity
without contrast...................................... 201
Computerized Axial Tomography (CAT) scan extremity with
contrast.............................................. 232
Computerized Axial Tomography (CAT) scan extremity with
and without contrast.................................. 306
Magnetic Resonance Imaging (MRI) without contrast...... 287
Magnetic Resonance Imaging (MRI) with contrast brain... 495
Magnetic Resonance Imaging (MRI) spine (all) chest and
abdomen without contrast.............................. 235
Magnetic Resonance Imaging (MRI) spine (all) with
contrast.............................................. 523
Magnetic Resonance Imaging (MRI) extremities without
contrast.............................................. 370
Magnetic Resonance Imaging (MRI) extremities with and
without contrast...................................... 287
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Inter- Common National
classification procedure -------------------------------------------------
Cosmetic surgery procedure diseases (ICD- terminology Full
9) (CPT)\5\ FY 94 charge\6\ reimbursement
----------------------------------------------------------------------------------------------------------------
D. Elective Cosmetic Surgery
Procedures and Rates
Mammaplasty.................. 85.50 19325 Surgical Care Services or........ $1,082
85.32 19324 Same Day Surgery................. 426
85.31 19318 ................................. .............
Mastopexy.................... 85.60 19316 Surgical Care Services or........ 1,082
Same Day Surgery................. .............
Facial....................... 86.82 15824 Surgical Care Services or........ 1,082
Rhytidectomy............. 86.22 ........... Same Day Surgery................. 426
Blepharoplasty............... 08.70 15820 Surgical Care Services or........ 1,082
08.44 15821 Same Day Surgery................. 426
.............. 15822 ................................. .............
.............. 15823 ................................. .............
Mentoplasty.................. 76.68 21208 Surgical Care Services or........ 1,082
(Augumentation Reduction) 76.67 21209 Same Day Surgery................. 426
Abdominoplasty............... 86.83 15831 Surgical Care Services or........ 1,082
Same Day Surgery................. 426
Lipectomy, suction per 86.83 15876 Surgical Care Services or........ 1,082
region\7\.
.............. 15877 Same Day Surgery................. 426
.............. 15878 ................................. .............
.............. 15879 ................................. .............
Rhinoplasty.................. 21.87 30400 Surgical Care Services or........ 1,082
21.86 30410 Same Day Surgery................. 426
Scar revisions beyond CHAMPUS 86.84 1587 Surgical Care Services or........ 1,082
Same Day Surgery................. 426
Mandibular or Maxillary 76.41 21194 Surgical Care Services or........ 1,082
Repositioning.
Same Day Surgery................. 426
Minor Skin Lesions\8\........ 86.30 1578 Surgical Care Services or........ 1,082
Same Day Surgery................. 426
Dermabrasion................. 86.25 15780 Surgical Care Services or........ 1,082
Same Day Surgery................. 426
Hair Restoration............. 86.64 15775 Surgical Care Services or........ 1,082
Same Day Surgery................. 426
Removing Tatoos.............. 86.25 15780 Surgical Care Services or........ 1,082
Same Day Surgery................. 426
Chemical Peel................ 86.24 15790 Surgical Care Services or........ 1,082
Same Day Surgery................. 426
Arm/Thigh Dermolipectomy..... 86.83 1583 Surgical Care Services or........ 1,082
Same Day Surgery................. 426
Brow Lift.................... 86.3 15839 Surgical Care Services or........ 1,082
Same Day Surgery................. 426
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Inpatient rate Items included
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E. Immunization.............................. $18.
F. Clinical Services by Types of Service/Care
Provided:
Medical Care Services.................... Internal Medicine, Cardiology, Dermatology, Endocrinology,
Gastroenterology, Hematology, Nephrology, Neurology, Oncology,
Pulmonary and Upper Respiratory Disease, Rheumatology, Physical
Medicine, Clinical Immunology, HIV-III Acquired Immune
Deficiency Syndrome (AIDS), Infectious Disease, Allergy, and
Medical Care not elsewhere classified. Includes Family Practice
Medical Care.
Surgical Care Services................... General Surgery, Cardiovascular and Thoracic Surgery,
Neurosurgery, Ophthalmology, Oral Surgery, Otorhinolaryngology,
Pediatric Surgery, Plastic Surgery, Proctology, Urology,
Peripheral Vascular Surgery, Trauma Center, Head and Neck
Surgery, and Surgical Care not elsewhere classified. Includes
Family Practice Surgical Care.
Obstetrical and Gynecological Care....... Included Family Practice Obstetrics and Gynecology.
Pediatric Care........................... Pediatrics, Nursery, Adolescent Pediatrics and Pediatric Care not
elsewhere classified. Includes Family Practice Pediatric and
Nursery Care.
Orthopedic Care.......................... Orthopedics, Podiatry and Hand Surgery. Includes Family Practice
Orthopedic Care.
Psychiatric Care and Substance Abuse Includes Family Practice Psychiatric Care.
Rehabilitation.
Medical Intensive Care/Coronary Care..... Self-Explanatory.
Surgical Intensive Care.................. Self-Explanatory.
Neonatal Intensive....................... Self-Explanatory.
Organ and Bone Marrow Transplants........ Self-Explanatory.
Same Day Surgery......................... Self-Explanatory.
----------------------------------------------------------------------------------------------------------------
Notes on Reimbursable Rates
\1\Daily percentages are applied to both inpatient and outpatient services provided when billing third party
payers (such as insurance companies). Pursuant to the provisions of 10 U.S.C. 1095, the inpatient daily
percentages are 55 percent hospital, 5 percent physician, 40 percent ancillary. The outpatient daily
percentages are 57 percent hospital, 10 percent physicians and 33 percent ancillary.
\2\DOD civilian employees located in overseas areas shall be rendered a bill when services are performed.
Payment is due 60 days from the date of the bill.
\3\Charges for PRIMUS/NAVCARE and high cost medications/services requested by external providers (Physicians,
Dentists, etc.) are only relevant to the Third Party Collection Program. Third party payers (such as insurance
companies) shall be billed for high cost services in those instances in which non-active duty eligible
beneficiaries have medical insurance and are seen by providers external to a Military Medical Treatment
Facility (MTF) obtain the prescribed service or medication from an MTF. Eligible beneficiaries are not
personally liable for this cost and shall not be billed by the MTF. The standard cost of high cost medications
includes the cost of the drugs and dispensing services.
\4\All quantities shown are tablets unless otherwise stated. The third party charge is only for the strengths
and the dosage cited. Charges will vary if the strengths and dosage are changed. The method of computing
standard costs to be charged for high cost medications is actual cost to the pharmacy, plus a 30 percent
dispensing fee. Only medications listed in this schedule may be billed. If a different dose is issued for a
medication that is listed, only bill if the cost is $100 or more.
\5\The attending physician is to complete the common procedure terminology code to indicate the appropriate
procedure followed during domestic surgery.
\6\Cosmetic surgery rates will be charged dependents of active duty members, retirees, and their dependents and
survivors. The patient shall be charged the rate as specified in the FY 1994 reimbursable rates for an episode
of care. The charges for elective cosmetic surgery are at the full reimbursement rate (designated as the other
rate) in section 1-2, page 1-7 entitled Inpatient and Outpatient Rates). The patient will be responsible for
both the cost of the implant(s) and prescribed rates.
Note: The implants and procedures used for the augmentation mammaplasty are in compliance with Federal Drug
Administration guidelines.
\7\Each regional lipectomy will carry a separate charge. Regions include head and neck, abdomen, flanks, and
hips.
\8\These procedures are inclusive in the minor skin lesions. However, CHAMPUS separates them as noted here. All
charges are for the entire treatment regardless of the number of visits required.
[FR Doc. 94-18061 Filed 7-28-94; 8:45 am]
BILLING CODE 3110-01-M
