State-prevailing rates

State-prevailing rates are established for codes that have no current available TRICARE allowable charge pricing. Prevailing rates are those charges that fall within the range of charges most frequently used in a state for a particular procedure or service.

When no fee schedule is available, a prevailing charge is developed for the state in which the service or procedure is provided. In lieu of a specific exception, prevailing profiles are developed on:

  • A statewide basis (localities within states are not used, nor are prevailing profiles developed for any area larger than individual states)
  • A non-specialty basis
See the current state-prevailing rates