This page serves as a central repository for rates within the TRICARE/CHAMPUS DRG-Based Payment System. Use the dropdowns below to view current and historical data related to DRG-Based Payments.

Based on the Final Rule [84 FR 4333] that published on February 15, 2019, the TRICARE DRG effective date will be delayed to January 1, for FY20 and beyond. See 32 CFR 199.14, (a)(1)(i)(D) DRG system updates. The CHAMPUS DRG-based payment system is modeled on the Medicare Prospective Payment System (PPS) and uses annually updated items and numbers from the Medicare PPS as provided for in this part and in instructions issued by the Director, DHA. The effective date of these items and numbers shall not correspond to that under Medicare PPS but shall be delayed until January 1, to align with TRICARE's program year reporting. This allows for an administrative simplicity that optimizes healthcare delivery by reducing existing administrative burden and costs.

• Calendar Year 2023
• Calendar Year 2022
• Calendar Year 2021

TRICARE has adopted the same Hospital-Acquired Conditions as CMS.

• FY 2016 and beyond HAC List (This Link will take you to the CMS ICD-10-CM/PCS HACs List site.)
• FY 2013, FY 2014, and FY 2015 Final HAC List (This list reflects ICD-9 codes through FY 2015. For FY 2016 and beyond, see the above link to CMS.)

• Changes to TRICARE Rate Variables (CY 2023)
• Cost-Share per diems for beneficiaries other than dependents of active duty service members:
  • CY 2023: $1,112
  • CY 2022: $1,053
  • CY 2021: $1,034
• DRGs Subject to Device Replacement Policy for Hospital Admissions on or after Oct. 1, 2009
• Uniformed Services Hospital Daily Charge Amounts
  • For Active Duty Family Members only: $0
  • For Active Duty Family Members not enrolled in TRICARE Prime:
    • CY 2024: $22.30 (Revised October 6, 2023)
    • CY 2023: $21.30 (Revised Nov. 2, 2022)
    • CY 2022: $20.75 (Revised Sept. 15, 2021)
• Historical Federal Register Notice