What TRICARE Pays to Providers
The maximum amount that TRICARE can pay a provider for a procedure or service is known as the TRICARE allowable chargeThe maximum amount TRICARE pays for each procedure or service. This is tied by law to Medicare's allowable charges.. The TRICARE allowable charge is tied by law to Medicare's allowable charge whenever practical and may vary based on the prevailing rate in a given location.
Rates and Reimbursement
The TRICARE Reimbursement Manual provides the methodology for pricing allowable services and items and for payment to specific categories and types of authorized providers. View the tools listed below to see rates TRICARE pays to providers. The amounts don't reflect a patient’s out of pocket cost shares, co-payments, deductibles, or payments made by any other health care coverage. Visit the Health Plan Costs page to view beneficiary out-of-pocket costs.
Provider Sanction Appeals
We may sanction -or expel- providers from TRICARE because they:
- Fail to maintain their credentials,
- Practice health care fraud or abuse,
- Have a conflict of interest, or
- Other reasons
Only a provider or their representative can AppealThe action you take if you don’t agree with a decision made about your benefit. a provider sanction decision. >>View the Sanctioned Provider List