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CHAMPUS Maximum Allowable Charge Rates

Please be advised that the presence of a CHAMPUS maximum allowable charge rate does not indicate coverage policy nor payment approval, but merely that a payment rate could be calculated for a Current Procedural Terminology/Healthcare Common Procedure Coding System code based on Medicare data or TRICARE claims history.

Also be advised that the absence of a CMAC rate does not indicate coverage policy or payment denial.

Please consult the TRICARE Policy / Reimbursement Manuals to determine TRICARE benefits and coverage. To view the list of codes that are excluded from coverage and are not payable under the TRICARE program, visit the No Government Pay Procedure Code List.

Last Updated: July 11, 2023
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