Federal Register, Volume 63 Issue 200 (Friday, October 16, 1998)

[Federal Register Volume 63, Number 200 (Friday, October 16, 1998)]
[Notices]
[Pages 55653-55659]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-27813]

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OFFICE OF MANAGEMENT AND BUDGET

Cost of Hospital and Medical Care 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 Pub. 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 two sets of 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 and 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:

1. Department of Defense

The FY 1999 Department of Defense (DoD) reimbursement rates for
inpatient, outpatient, and other services are provided in accordance
with Section 1095 of title 10, United States Code. Due to size, the
sections containing the Drug Reimbursement Rates (Section III.E) and
the rates for Ancillary Services Requested by Outside Providers
(Section III.F) are not included in this package. The Office of the
Assistant Secretary of Defense (Health Affairs) will provide these
rates upon request. The medical and dental service rates in this
package (including the rates for ancillary services, prescription drugs
or other procedures requested by outside providers) are effective
October 1, 1998.

2. Health and Human Services

The sum of obligations for each cost center providing medical
service is broken down into amounts attributable to inpatient care on
the basis of the proportion of staff devoted to each cost center. Total
inpatient costs and outpatient costs thus determined are divided by the
relevant workload statistic (inpatient day, outpatient visit) to
produce the inpatient and outpatient rates. In calculation of the
rates, the Department's unfunded retirement liability cost and capital
and equipment depreciation cost were incorporated to conform to
requirements set forth in OMB Circular A-25. In addition, each cost
center's obligations include obligations from certain other accounts,
such as Medicare and Medicaid collections and Contract Health funds
that were used to support direct program operations. Certain cost
centers that primarily support workload outside of the directly
operated hospitals or clinics (public health nursing, public health
nutrition, health education) were excluded. These obligations are not a
part of the traditional cost of hospital operations and do not
contribute directly to the inpatient and outpatient visit workload.
Overall, these rates reflect a more accurate indication of the cost of
care in HHS facilities.
In addition, separate rates per inpatient day and outpatient visit
were computed for Alaska and the rest of the United States. This gives
proper weight to the higher cost of operating medical facilities in
Alaska.

1. Department of Defense

For the Department of Defense, effective October 1, 1998 and
thereafter:

[[Page 55654]]

Inpatient, Outpatient and Other Rates and Charge

I. Inpatient Rates \1\ \2\

----------------------------------------------------------------------------------------------------------------
Interagency
International and other Other
military federal agency sponsored
education per and training patients
inpatient day (IMET)
----------------------------------------------------------------------------------------------------------------
A. Burn Center.................................................. $2,538.00 $4,632.00 $4,952.00
B. Surgical Care Services (Cosmetic Surgery).................... 1,236.00 2,255.00 2,411.00
----------------------------------------------------------------------------------------------------------------

C. All Other Inpatient Services (Based on Diagnosis Related Groups
(DRG) \3\)
1. FY99 Direct Care Inpatient Reimbursement Rates

----------------------------------------------------------------------------------------------------------------
Other (full/
Adjusted standard amount IMET Interagency third party)
----------------------------------------------------------------------------------------------------------------
Large Urban..................................................... $2,429.00 $4,552.00 $4,825.00
Other Urban/Rural............................................... 2,642.00 5,413.00 5,760.00
Overseas........................................................ 2,989.00 6,823.00 7,234.00
----------------------------------------------------------------------------------------------------------------

2. Overview
The FY99 inpatient rates are based on the cost per DRG, which is
the inpatient full reimbursement rate per hospital discharge weighted
to reflect the intensity of the principal diagnosis, secondary
diagnoses, procedures, patient age, etc. involved. The average cost per
Relative Weighted Product (RWP) for large urban, other urban/rural, and
overseas facilities will be published annually as an inpatient adjusted
standardized amount (ASA) (see paragraph I.C.1. above). The ASA will be
applied to the RWP for each inpatient case, determined from the DRG
weights, outlier thresholds, and payment rules published annually for
hospital reimbursement rates under the Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) pursuant to 32 CFR
199.14(a)(1), including adjustments for length of stay (LOS) outliers.
The published ASAs will be adjusted for area wage differences and
indirect medical education (IME) for the discharging hospital. An
example of how to apply DoD costs to a DRG standardized weight to
arrive at DoD costs is contained in paragraph I.C.3., below.
3. Example of Adjusted Standardized Amounts for Inpatient Stays
Figure 1 Shows Examples for a Nonteaching Hospital in a Large Urban
Area
a. The cost to be recovered is DoD's cost for medical services
provided in the nonteaching hospital located in a large urban area.
Billings will be at the third party rate.
b. DRG 020: Nervous System Infection Except Viral Meningitis. The
RWP for an inlier case is the CHAMPUS weight of 2.9769. (DRG statistics
shown are from FY 1997).
c. The DoD adjusted standardized amount to be charged is $4,825
(i.e., the third party rate as shown in the table).
d. DoD cost to be recovered at a nonteaching hospital with area
wage index of 1.0 is the RWP factor (2.9769) in 3.b., above, multiplied
by the amount ($4,825) in 3.c., above.
e. Cost to be recovered is $14,364.

Figure 1.--Third Party Billing Examples
----------------------------------------------------------------------------------------------------------------
Arithmetic Geometric Short stay Long stay
DRG No. DRG description DRG weight mean LOS mean LOS threshold threshold
----------------------------------------------------------------------------------------------------------------
020.................. Nervous System Infection 2.9769 11.2 7.8 1 30
Except Viral Meningitis.
----------------------------------------------------------------------------------------------------------------

Nonteaching Hospital............. Large Urban.............. 1.0 1.0 $4,825.00 $4,825.00
----------------------------------------------------------------------------------------------------------------

#1..................... 7 days................ 0 2.9769 0.0000 2.9769 $14,364
#2..................... 21 days............... 0 2.9769 0.0000 2.9769 14,364
#3..................... 35 days............... 5 2.9769 0.6297 3.6066 17,402
----------------------------------------------------------------------------------------------------------------
*DRG Weight.
**Outlier calculation=33 percent of per diem weight x number of outlier days=.33 (DRG Weight/Geometric Mean
LOS) x (Patient LOS--Long Stay Threshold).
=.33 (2.9769/7.8) x (35-30).
=.33 (.38165) x 5 (take out to five decimal places).
=.12594 x 5 (take out to five decimal places).
=.6297 (take out to four decimal places).
***Applied ASA x Total RWP.

[[Page 55655]]

II. Outpatient Rates ¹ ² Per Visit

----------------------------------------------------------------------------------------------------------------
International Interagency &
military other federal Other (full/
MEPRS code \4\ Clinical service education & agency sponsored third party)
training (IMET) patients
----------------------------------------------------------------------------------------------------------------
A. Medical Care
----------------------------------------------------------------------------------------------------------------
BAA........................ Internal Medicine......... $104.00 $186.00 $198.00
BAB........................ Allergy................... 48.00 86.00 92.00
BAC........................ Cardiology................ 78.00 140.00 149.00
BAE........................ Diabetic.................. 57.00 102.00 108.00
BAF........................ Endocrinology (Metabolism) 90.00 162.00 173.00
BAG........................ Gastroenterology.......... 114.00 205.00 219.00
BAH........................ Hematology................ 145.00 260.00 277.00
BAI........................ Hypertension.............. 89.00 160.00 170.00
BAJ........................ Nephrology................ 138.00 245.00 261.00
BAK........................ Neurology................. 112.00 200.00 213.00
BAL........................ Outpatient Nutrition...... 33.00 59.00 63.00
BAM........................ Oncology.................. 132.00 236.00 251.00
BAN........................ Pulmonary Disease......... 118.00 211.00 225.00
BAO........................ Rheumatology.............. 84.00 151.00 160.00
BAP........................ Dermatology............... 68.00 122.00 130.00
BAQ........................ Infectious Disease........ 126.00 225.00 240.00
BAR........................ Physical Medicine......... 74.00 133.00 142.00
BAS........................ Radiation Therapy......... 91.00 164.00 174.00
----------------------------------------------------------------------------------------------------------------
B. Surgical Care
----------------------------------------------------------------------------------------------------------------
BBA........................ General Surgery........... 164.00 295.00 314.00
BBB........................ Cardiovascular and 132.00 237.00 252.00
Thoracic Surgery.
BBC........................ Neurosurgery.............. 188.00 337.00 359.00
BBD........................ Ophthalmology............. 102.00 183.00 194.00
BBE........................ Organ Transplant.......... 239.00 429.00 457.00
BBF........................ Otolaryngology............ 124.00 222.00 237.00
BBG........................ Plastic Surgery........... 129.00 231.00 247.00
BBH........................ Proctology................ 65.00 117.00 124.00
BBI........................ Urology................... 125.00 224.00 239.00
BBJ........................ Pediatric Surgery......... 91.00 163.00 174.00
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C. Obstetrical and Gynecological (OB-GYN) Care
----------------------------------------------------------------------------------------------------------------
BCA........................ Family Planning........... 45.00 81.00 87.00
BCB........................ Gynecology................ 101.00 181.00 193.00
BCC........................ Obstetrics................ 72.00 129.00 137.00
BCD........................ Breast Cancer Clinic...... 171.00 307.00 327.00
----------------------------------------------------------------------------------------------------------------
D. Pediatric Care
----------------------------------------------------------------------------------------------------------------
BDA........................ Pediatric................. 63.00 113.00 120.00
BDB........................ Adolescent................ 60.00 108.00 115.00
BDC........................ Well Baby................. 40.00 71.00 76.00
----------------------------------------------------------------------------------------------------------------
E. Orthopaedic Care
----------------------------------------------------------------------------------------------------------------
BEA........................ Orthopaedic............... 118.00 212.00 226.00
BEB........................ Cast...................... 50.00 90.00 96.00
BEC........................ Hand Surgery.............. 61.00 109.00 116.00
BEE........................ Orthotic Laboratory....... 60.00 108.00 115.00
BEF........................ Podiatry.................. 67.00 119.00 127.00
BEZ........................ Chiropractic.............. 24.00 42.00 45.00
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F. Psychiatric and/or Mental Health Care
----------------------------------------------------------------------------------------------------------------
BFA........................ Psychiatry................ 97.00 174.00 186.00
BFB........................ Psychology................ 79.00 141.00 150.00
BFC........................ Child Guidance............ 52.00 93.00 99.00
BFD........................ Mental Health............. 105.00 188.00 201.00
BFE........................ Social Work............... 77.00 137.00 146.00
BFF........................ Substance Abuse........... 82.00 147.00 156.00
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G. Family Practice/Primary Medical Care
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BGA........................ Family Practice........... 74.00 133.00 141.00
BHA........................ Primary Care.............. 75.00 134.00 143.00
BHB........................ Medical Examination....... 66.00 118.00 126.00

[[Page 55656]]

BHC........................ Optometry................. 48.00 86.00 91.00
BHD........................ Audiology................. 27.00 49.00 52.00
BHE........................ Speech Pathology.......... 69.00 123.00 131.00
BHF........................ Community Health.......... 48.00 87.00 92.00
BHG........................ Occupational Health....... 78.00 141.00 150.00
BHH........................ TRICARE Outpatient........ 44.00 79.00 84.00
BHI........................ Immediate Care............ 108.00 193.00 206.00
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H. Emergency Medical Care
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BIA........................ Emergency Medical......... 114.00 205.00 218.00
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I. Flight Medical Care
----------------------------------------------------------------------------------------------------------------
BJA........................ Flight Medicine........... 103.00 185.00 197.00
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J. Underseas Medical Care
----------------------------------------------------------------------------------------------------------------
BKA........................ Underseas Medicine........ 35.00 63.00 67.00
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K. Rehabilitative Services
----------------------------------------------------------------------------------------------------------------
BLA........................ Physical Therapy.......... 34.00 60.00 64.00
BLB........................ Occupational Therapy...... 48.00 86.00 91.00
----------------------------------------------------------------------------------------------------------------

III. Other Rates and Charges \1\ \2\ Per Visit

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International Interagency and
Military other federal Other (full/
MEPRS Code \4\ Clinical service Education & agency sponsored third party)
Training (IMET) patients
----------------------------------------------------------------------------------------------------------------
FBI........................ A. Immunization........... $13.00 $22.00 $24.00
DGC........................ B. Hyperbaric Chamber \5\. 191.00 343.00 366.00
C. Ambulatory Procedure 926.00 1,657.00 1,765.00
Visit (APV) \6\.
D. Family Member Rate 10.45 ................. .................
(formerly Military
Dependents Rate).
----------------------------------------------------------------------------------------------------------------

E. Reimbursement Rates For Drugs Requested By Outside Providers \7\
The FY 1999 drug reimbursement rates for drugs are for
prescriptions requested by outside providers and obtained at a Military
Treatment Facility. The rates are established based on the cost of the
particular drugs provided. Final rule 32 CFR part 220 eliminates the
high cost ancillary services' dollar threshold and the associated term
``high cost ancillary service.'' The phrase ``high cost ancillary
service'' will be replaced with the phrase ``ancillary services
requested by an outside provider'' on publication of final rule 32 CFR
part 220. The list of drug reimbursement rates is too large to include
here. These rates are available on request from OASD (Health Affairs).
F. Reimbursement Rates for Ancillary Services Requested By Outside
Providers \8\
Final rule 32 CFR part 220 eliminates the high cost ancillary
services' dollar threshold and the associated term ``high cost
ancillary service.'' The phrase ``high cost ancillary service'' will be
replaced with the phrase ``ancillary services requested by an outside
provider'' on publication of final rule 32 CFR part 220. The list of FY
1999 rates for ancillary services requested by outside providers and
obtained at a Military Treatment Facility is too large to include here.
These rates are available on request from OASD (Health Affairs).
G. Elective Cosmetic Surgery Procedures and Rates

----------------------------------------------------------------------------------------------------------------
International Current procedural
Cosmetic surgery procedure Classification terminology (CPT) FY 1999 charge \10\ Amount of
Diseases (ICD-9) \9\ charge
----------------------------------------------------------------------------------------------------------------
Mammaplasty.................... 85.50, 85.32, 19325, 19324, Inpatient Surgical (^{a ^{b ^{c)
85.31. 19318. Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Mastopexy...................... 85.60............. 19316............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem Or APV
or applicable
Outpatient Clinic
Rate.
Facial Rhytidectomy............ 86.82, 86.22...... 15824............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Blepharoplasty................. 08.70, 08.44...... 15820, 15821, Inpatient Surgical (^{a ^{b ^{c)
15822, 15823. Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Mentoplasty (Augmentation/ 76.68, 76.67...... 21208, 21209...... Inpatient Surgical (^{a ^{b ^{c)
Reduction). Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Abdominoplasty................. 86.83............. 15831............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Lipectomy suction per region 86.83............. 15876, 15877, Inpatient Surgical (^{a ^{b ^{c)
\11\. 15878, 15879. Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.

[[Page 55657]]

Rhinoplasty.................... 21.87, 21.86...... 30400, 30410...... Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Scar Revisions beyond CHAMPUS.. 86.84............. 15785............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Mandibular or Maxillary 76.41............. 21194............. Inpatient Surgical (^{a ^{b ^{c)
Repositioning. Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Minor Skin Lesions \12\........ 86.30............. 15785............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Dermabrasion................... 86.25............. 15780............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Hair Restoration............... 86.64............. 15775............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Removing Tattoos............... 86.25............. 15780............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Chemical Peel.................. 86.24............. 15790............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Arm/Thigh Dermolipectomy....... 86.83............. 15839............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
Brow Lift...................... 86.3.............. 15839............. Inpatient Surgical (^{a ^{b ^{c)
Care Per Diem or APV
or applicable
Outpatient Clinic
Rate.
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H. Dental Rate \13\ Per Procedure

I. Ambulance Rate \14\ Per Visit

J. Ancillary Services Requested by an Outside Provider \8\ Per
Procedure

K. AirEvac Rate \15\ Per Visit

Observation Rate \16\ Per Hour

[[Page 55658]]

Notes on Cosmetic Surgery Charges

^a Per diem charges for inpatient surgical care
services are listed in Section I.B. (See notes 9 through 11, below,
for further details on reimbursable rates.)
^b Charges for ambulatory procedure visits (formerly
same day surgery) are listed in Section III.C. (See notes 9 through
11, below, for further details on reimbursable rates.) The
ambulatory procedure visit (APV) rate is used if the elective
cosmetic surgery is performed in an ambulatory procedure unit (APU).
^c Charges for outpatient clinic visits are listed in
Sections II.A-K. The outpatient clinic rate is not used for services
provided in an APU. The APV rate should be used in these cases.

Notes on Reimbursable Rates

\1\ Percentages can be applied when preparing bills for both
inpatient and outpatient services. Pursuant to the provisions of 10
U.S.C. 1095, the inpatient Diagnosis Related Groups and inpatient
per diem percentages are 96 percent hospital and 4 percent
professional charges. The outpatient per visit percentages are 89
percent outpatient services and 11 percent professional charges.
\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\ The cost per Diagnosis Related Group (DRG) is based on the
inpatient full reimbursement rate per hospital discharge, weighted
to reflect the intensity of the principal and secondary diagnoses,
surgical procedures, and patient demographics involved. The adjusted
standardized amounts (ASA) per Relative Weighted Product (RWP) for
use in the direct care system is comparable to procedures used by
the Health Care Financing Administration (HCFA) and the Civilian
Health and Medical Program for the Uniformed Services (CHAMPUS).
These expenses include all direct care expenses associated with
direct patient care. The average cost per RWP for large urban, other
urban/rural, and overseas will be published annually as an adjusted
standardized amount (ASA) and will include the cost of inpatient
professional services. The DRG rates will apply to reimbursement
from all sources, not just third party payers.
\4\ The Medical Expense and Performance Reporting System (MEPRS)
code is a three digit code which defines the summary account and the
subaccount within a functional category in the DoD medical system.
MEPRS codes are used to ensure that consistent expense and operating
performance data is reported in the DoD military medical system. An
example of the MEPRS hierarchical arrangement follows:

MEPRS Code

Outpatient Care (Functional Category) B
Medical Care (Summary Account) BA
Internal Medicine (Subaccount) BAA
\5\ Hyperbaric services charges shall be based on hours of
service in 15 minute increments. The rates listed in Section III.B.
are for 60 minutes or 1 hour of service. Providers shall calculate
the charges based on the number of hours (and/or fractions of an
hour) of service. Fractions of an hour shall be rounded to the next
15 minute increment (e.g., 31 minutes shall be charged as 45
minutes).
\6\ Ambulatory procedure visit is defined in DOD Instruction
6025.8, ``Ambulatory Procedure Visit (APV),'' dated September 23,
1996, as immediate (day of procedure) pre-procedure and immediate
post-procedure care requiring an unusual degree of intensity and
provided in an ambulatory procedure unit (APU). Care is required in
the facility for less than 24 hours. This rate is also used for
elective cosmetic surgery performed in an APU.
\7\ Prescription services requested by outside providers (e.g.,
physicians or dentists) are relevant to the Third Party Collection
Program. Third party payers (such as insurance companies) shall be
billed for prescription services when beneficiaries who have medical
insurance obtain medications from a Military Treatment Facility
(MTF) that are prescribed by providers external to the MTF. Eligible
beneficiaries (family members or retirees with medical insurance)
are not personally liable for this cost and shall not be billed by
the MTF. Medical Services Account (MSA) patients, who are not
beneficiaries as defined in 10 U.S.C. 1074 and 1076, are charged at
the ``Other'' rate if they are seen by an outside provider and only
come to the MTF for prescription services. The standard cost of
medications ordered by an outside provider includes the cost of the
drugs plus a dispensing fee per prescription. The prescription cost
is calculated by multiplying the number of units (e.g., tablets or
capsules) by the unit cost and adding a $5.00 dispensing fee per
prescription. Final rule 32 CFR part 220 eliminates the high cost
ancillary services' dollar threshold and the associated term ``high
cost ancillary service.'' The phrase ``high cost ancillary service''
will be replaced with the phrase ``ancillary services requested by
an outside provider'' on publication of final rule 32 CFR part 220.
The elimination of the threshold also eliminates the need to bundle
costs whereby a patient is billed if the total cost of ancillary
services in a day (defined as 0001 hours to 2400 hours) exceeded
$25.00. The elimination of the threshold is effective as per date
stated in final rule 32 CFR part 220.
\8\ Charges for ancillary services requested by an outside
provider (physicians, dentists, etc.) are relevant to the Third
Party Collection Program. Third party payers (such as insurance
companies) shall be billed for ancillary services when beneficiaries
who have medical insurance obtain services from the MTF that are
prescribed by providers external to the MTF. Laboratory and
Radiology procedure costs are calculated by multiplying the DoD
established weight for the Physicians' Current Procedural
Terminology (CPT `98) code by either the cardiology, laboratory or
radiology multiplier (Section III.J). Eligible beneficiaries (family
members or retirees with medical insurance) are not personally
liable for this cost and shall not be billed by the MTF. MSA
patients, who are not beneficiaries as defined by 10 U.S.C. 1074 and
1076, are charged at the ``Other'' rate if they are seen by an
outside provider and only come to the MTF for ancillary services.
Final rule 32 CFR part 220 eliminates the high cost ancillary
services' dollar threshold and the associated term ``high cost
ancillary service.'' The phrase ``high cost ancillary service'' will
be replaced with the phrase ``ancillary services requested by an
outside provider'' on publication of final rule 32 CFR part 220. The
elimination of the threshold also eliminates the need to bundle
costs whereby a patient is billed if the total cost of ancillary
services in a day (defined as 0001 hours to 2400 hours) exceeded
$25.00. The elimination of the threshold is effective as per date
stated in final rule 32 CFR part 220.
\9\ The attending physician is to complete the CPT `98 code to
indicate the appropriate procedure followed during cosmetic surgery.
The appropriate rate will be applied depending on the treatment
modality of the patient: ambulatory procedure visit, outpatient
clinic visit or inpatient surgical care services.
\10\ Family members of active duty personnel, retirees and their
family members, and survivors shall be charged elective cosmetic
surgery rates. Elective cosmetic surgery procedure information is
contained in Section III.G. The patient shall be charged the rate as
specified in the FY 1999 reimbursable rates for an episode of care.
The charges for elective cosmetic surgery are at the full
reimbursement rate (designated as the ``Other'' rate) for inpatient
per diem surgical care services in Section I.B., ambulatory
procedure visits as contained in Section III.C, or the appropriate
outpatient clinic rate in Sections II.A-K. The patient is
responsible for the cost of the implant(s) and the prescribed
cosmetic surgery rate. (Note: The implants and procedures used for
the augmentation mammaplasty are in compliance with Federal Drug
Administration guidelines.)

[[Page 55659]]

\11\ Each regional lipectomy shall carry a separate charge.
Regions include head and neck, abdomen, flanks, and hips.
\12\ These procedures are inclusive in the minor skin lesions.
However, CHAMPUS separates them as noted here. All charges shall be
for the entire treatment, regardless of the number of visits
required.
\13\ Dental service rates are based on a dental rate multiplier
times the American Dental Association (ADA) code and the DoD
established weight for that code.
\14\ Ambulance charges shall be based on hours of service in 15
minute increments. The rates listed in Section III.I are for 60
minutes or 1 hour of service. Providers shall calculate the charges
based on the number of hours (and/or fractions of an hour) that the
ambulance is logged out on a patient run. Fractions of an hour shall
be rounded to the next 15 minute increment (e.g., 31 minutes shall
be charged as 45 minutes).
\15\ Air in-flight medical care reimbursement charges are
determined by the status of the patient (ambulatory or litter) and
are per patient. The appropriate charges are billed only by the Air
Force Global Patient Movement Requirement Center (GPMRC).
\16\ Observation Services are billed at either the hourly or
daily charge. Begin counting when the patient is placed in the
observation bed, and round to the nearest hour. The daily rate for
full/third party, for example, would be $660 based on 24 hours of
service. If a patient status changes to inpatient, the charges for
observation services are added to the DRG assigned to the case and
not billed separately. If a patient is released from Observation
status and is sent to an APV, the charges for Observation services
are not billed separately, but are added to the APV rate in order to
recover all expenses.

1. Department of Health and Human Services

For the Department of Health and Human Services, Indian Health
Service, effective October 1, 1998 and thereafter:

Hospital Care Inpatient Day

General Medical Care:
Alaska................................................. $1,798
Rest of the United States.............................. 1,049

Outpatient Medical Treatment

Outpatient Visit:
Alaska................................................. $360
Rest of the United States.............................. 210

For the period beginning October 1, 1998, the rates prescribed
herein superseded those established by the Director of the Office of
Management and Budget October 31, 1997 (61 FR 56360).
Jacob Lew,
Director, Office of Management and Budget.
[FR Doc. 98-27813 Filed 10-15-98; 8:45 am]
BILLING CODE 3110-01-P}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}