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MHS Rates : Inpatient

Direct Care Inpatient Billing Rates

The Department of Defense inpatient reimbursement rates posted below are approved and available on the DoD Comptroller Web site. These reimbursement rates are used when billing for medical services provided to inpatients at Military Treatment Facilities.

The FY13 direct care inpatient ASA billing rates have been updated, effective October 1, 2012. The ASA rates were updated to maintain the percent increase in direct care ASA charges consistent with the final TRICARE percent increase in inpatient institutional payment for FY13. (posted 10-2-2012)

• NEW! Fiscal Year 2013 Inpatient charges effective 1 October 2012
  FY13 Direct Care Inpatient Billing Rates pdf 1881.4 KB (posted 10-2-2012)



• Fiscal Year 2012 Inpatient charges effective 1 January 2012
  FY 12 Direct Care Inpatient Billing Rates Update pdf 4004.3 KB (posted 1-10-12)
• Fiscal Year 2012 Inpatient Charges Effective 1 October 2011
  FY12 Direct Care Inpatient Billing Rates pdf 4266.7 KB

Long Stay Threshold

The Long Stay Threshold (LST) for DoD Inpatient Health Care is a national number used to determine if a patient has exceeded the length of stay (LOS) threshold for the Diagnosis Related Group (DRG) assigned to his or her inpatient stay. When the LOS exceeds the LST, there will be an additional charge included in the bill.

The calculation is descibed below:

Per Diem Weight = DRG Relative Weighted Product (RWP) / Geometric Mean LOS.

The charge for each day in excess of the LST = Per Diem Weight x .33 x MTF Adjusted Standardized Amount (ASA).

The total billed amount = (DRG RWP x MTF ASA) + (Per Diem Weight x .33 x # days in excess of LST x MTF ASA). Below are tables that provide DRG weights and length of stay information.

• NEW! This table provides the DRG weights and length of stay outlier threshold data for FY13.
  2013_DRG_Case_Weights_LOS_Outliers xlsx 71.2 KB (posted 10-5-2012)
• This table provides the DRG weights and length of stay outlier threshold data for FY12.
  2012_DRG_Case_Weights_LOS_Outliers xlsx 61.0 KB

Older Rates information can be found on the Archives page.

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