Start-Up ServicesIt is not unusual for us to be asked 3-4 times per week about fees and how much the VA or Tricare pays for a particular procedure. The VA will typically reimburse providers at 100% of the CMAC fee schedule whereas Tricare will typically pay a percentage of the CMAC fee schedule. Tricare fees are based on your region and could be more or less than the CMAC fee schedule. You should never accept a Tricare contract that has more than a 8-10% discount off of CMAC. We prefer all agreements to be within 5% of the CMAC fee schedule but again, this depends on where the group is located.
If you are trying to evaluate a Tricare contract or compare fees under CMAC, the below links are a great place to start.
CMAC Fee Schedule Tools
Here is a link to some tools used to find out the allowable charge for different procedure codes. It is based on region so you have to add your locality before determining rates.
Tricare CMAC Tool: http://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges
If you want to download a full fee schedule or do a cross code lookup, here is where you can do it: http://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/CMAC-Rates