Temporary Transitional Payment Adjustments (TTPA)

TTPAs are in place for all hospitals, both network and non-network, to buffer the initial decline in payments upon implementation of TRICARE OPPS. For network hospitals, the TTPAs cover a four-year period.

The four-year transition sets higher payment percentages for the 10 APC codes for Emergency Room (ER) and hospital clinic visits (APC codes 604 to 609 and 613 to 616), with reductions in each transition year. For non-network hospitals, the TTPAs cover a three-year period, with reductions in each transition year.

TRICARE rates update schedule

Update frequency Rates scheduled to change
Variable at TMA's discretion
  • TRICARE allowable charge, also known as the CHAMPUS Maximum Allowable Charge (CMAC). Allowable profiles are typically updated at least once per year, usually in the first quarter of the year.
  • Anesthesia
  • Injectables and immunizations
April 1
  • Birthing centers
October 1
  • Diagnosis-Related Group (DRG)
  • Residential Treatment Center (RTC)
  • Behavioral health per diem
  • Skilled Nursing Facility (SNF)
  • Prospective payment system (may be adjusted quarterly)
  • Inpatient hospital copays and cost-shares hospice
November 1
  • Ambulatory surgery grouper
December 1
  • Critical Access Hospitals (CAH)
Quarterly (January, April, July, October)
  • Durable Medical Equipment (DME), Prosthetics, Orthotics and Supplies (DMEPOS)
  • Home Health Prosective Payment System (PPS)
  • Outpatient Prospective Payment System (OPPS)