View the TRICARE OPPS Calculator Results

Use the TRICARE OPPS Calculator Results page to view the expected reimbursement for TRICARE Outpatient claims.

Field Descriptions

The following table describes each of the fields on the TRICARE OPPS Calculator Results page.

Field	Description
Selection Criteria
Bill Type	Bill type
Discharge Status	Patient’s destination upon discharge (home, LTC, and so on)
Patient DOB	Patient birth date
Patient Sex	Patient gender
Service From	First date of service rendered to the patient. This is required information, and defaults to today’s date. Cannot be prior to Date of Birth.
Service Through	Ending date the service was performed; required information; defaults to today’s date. Cannot be prior to Service From date.
Payment Totals
Reimbursement	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Total APC Payment	Reimbursement from the APC, a set of payment rates based on groups of outpatient services rather than on individual services
Pass-through Payment	Reimbursement for certain high-cost items like implants, high cost drugs and biologicals, for which the actual or higher cost is passed through to the payor
Fee Schedule Payment	Reimbursement from a fee schedule (Lab, DMEPOS, PEN, and therapies)
Other Payment	Reimbursement for other items not typically included on an OPPS claim (such as Psych, blood factors, or organ transplants).
Total Claim Outlier Payment	Payment for cases incurring extraordinarily high costs
Total Payment	Total payment
Payment Totals
No.	Sequential number of the account in the current set of accounts, based on the sort method
Service Date	Date the service was rendered
Rev Code	Revenue code
CPT/HCPC Codes & Modifiers	Associated CPT or HCPC codes and modifiers
APC Codes	Ambulatory Payment Classification codes
Status Codes	APC payment status codes
Billed Units	Number of units billed
Allowed Units	Number of units allowed
Expected Payment	Total expected payment for the line
Outlier Amount	Payment amount for cases incurring extraordinarily high costs
Total Payment by APC	Reimbursement from the APC, a set of payment rates based on groups of outpatient services rather than on individual services
Reason Code	Reason a specific line item was denied or description of how it was paid