Office of Management and Budget

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T H E W H I T E H O U S E

Cost of Hospital and Medical Care Treatment Furnished by the United States

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^b Charges for ambulatory procedure visits (formerly same day surgery) are listed in Section III.C. (See notes 9 through 11, below, for further details on reimbursable rates.) The ambulatory procedure visit (APV) rate is used if the elective cosmetic surgery is performed in an ambulatory procedure unit (APU).

^c Charges for outpatient clinic visits are listed in Sections II.A-K. The outpatient clinic rate is not used for services provided in an APU. The APV rate should be used in these cases.

Notes on Reimbursable Rates

¹ Percentages can be applied when preparing bills for both inpatient and outpatient services. Pursuant to the provisions of 10 U.S.C. 1095, the inpatient Diagnosis Related Groups and inpatient per diem percentages are 96 percent hospital and 4 percent professional charges. The outpatient per visit percentages are 89 percent outpatient services and 11 percent professional charges.

² DoD civilian employees located in overseas areas shall be rendered a bill when services are performed. Payment is due 60 days from the date of the bill.

³ The cost per Diagnosis Related Group (DRG) is based on the inpatient full reimbursement rate per hospital discharge, weighted to reflect the intensity of the principal and secondary diagnoses, surgical procedures, and patient demographics involved. The adjusted standardized amounts (ASA) per Relative Weighted Product (RWP) for use in the direct care system is comparable to procedures used by the Health Care Financing Administration (HCFA) and the Civilian Health and Medical Program for the Uniformed Services (CHAMPUS). These expenses include all direct care expenses associated with direct patient care. The average cost per RWP for large urban, other urban/rural, and overseas will be published annually as an adjusted standardized amount (ASA) and will include the cost of inpatient professional services. The DRG rates will apply to reimbursement from all sources, not just third party payers.

⁴ The Medical Expense and Performance Reporting System (MEPRS) code is a three digit code which defines the summary account and the sub account within a functional category in the DoD medical system. MEPRS codes are used to ensure that consistent expense and operating performance data is reported in the DoD military medical system. An example of the MEPRS hierarchical arrangement follows:

MEPRS CODE

Outpatient Care (Functional Category) B
Medical Care (Summary Account) BA
Internal Medicine (Subaccount) BAA

⁵ Hyperbaric services charges shall be based on hours of service in 15 minute increments. The rates listed in Section III.B. are for 60 minutes or 1 hour of service. Providers shall calculate the charges based on the number of hours (and/or fractions of an hour) of service. Fractions of an hour shall be rounded to the next 15 minute increment (e.g., 31 minutes shall be charged as 45 minutes).

⁶ Ambulatory procedure visit is defined in DOD Instruction 6025.8, "Ambulatory Procedure Visit (APV)," dated September 23, 1996, as immediate (day of procedure) pre-procedure and immediate post-procedure care requiring an unusual degree of intensity and provided in an ambulatory procedure unit (APU). Care is required in the facility for less than 24 hours. This rate is also used for elective cosmetic surgery performed in an APU.

⁷ Prescription services requested by outside providers (e.g., physicians or dentists) are relevant to the Third Party Collection Program. Third party payers (such as insurance companies) shall be billed for prescription services when beneficiaries who have medical insurance obtain medications from a Military Treatment Facility (MTF) that are prescribed by providers external to the MTF. Eligible beneficiaries (family members or retirees with medical insurance) are not personally liable for this cost and shall not be billed by the MTF. Medical Services Account (MSA) patients, who are not beneficiaries as defined in 10 U.S.C. 1074 and 1076, are charged at the "Other" rate if they are seen by an outside provider and only come to the MTF for prescription services. The standard cost of medications ordered by an outside provider includes the cost of the drugs plus a dispensing fee per prescription. The prescription cost is calculated by multiplying the number of units (e.g., tablets or capsules) by the unit cost and adding a $5.00 dispensing fee per prescription. Final rule 32 CFR Part 220 eliminates the high cost ancillary services' dollar threshold and the associated term "high cost ancillary service." The phrase "high cost ancillary service" will be replaced with the phrase "ancillary services requested by an outside provider" on publication of final rule 32 CFR Part 220. The elimination of the threshold also eliminates the need to bundle costs whereby a patient is billed if the total cost of ancillary services in a day (defined as 0001 hours to 2400 hours) exceeded $25.00. The elimination of the threshold is effective as per date stated in final rule 32 CFR Part 220.

⁸ Charges for ancillary services requested by an outside provider (physicians, dentists, etc.) are relevant to the Third Party Collection Program. Third party payers (such as insurance companies) shall be billed for ancillary services when beneficiaries who have medical insurance obtain services from the MTF that are prescribed by providers external to the MTF. Laboratory and Radiology procedure costs are calculated by multiplying the DoD established weight for the Physicians' Current Procedural Terminology (CPT '98) code by either the cardiology, laboratory or radiology multiplier (Section III.J). Eligible beneficiaries (family members or retirees with medical insurance) are not personally liable for this cost and shall not be billed by the MTF. MSA patients, who are not beneficiaries as defined by 10 U.S.C. 1074 and 1076, are charged at the "Other" rate if they are seen by an outside provider and only come to the MTF for ancillary services. Final rule 32 CFR Part 220 eliminates the high cost ancillary services' dollar threshold and the associated term "high cost ancillary service." The phrase "high cost ancillary service" will be replaced with the phrase "ancillary services requested by an outside provider" on publication of final rule 32 CFR Part 220. The elimination of the threshold also eliminates the need to bundle costs whereby a patient is billed if the total cost of ancillary services in a day (defined as 0001 hours to 2400 hours) exceeded $25.00. The elimination of the threshold is effective as per date stated in final rule 32 CFR Part 220.

⁹ The attending physician is to complete the CPT '98 code to indicate the appropriate procedure followed during cosmetic surgery. The appropriate rate will be applied depending on the treatment modality of the patient: ambulatory procedure visit, outpatient clinic visit or inpatient surgical care services.

¹⁰ Family members of active duty personnel, retirees and their family members, and survivors shall be charged elective cosmetic surgery rates. Elective cosmetic surgery procedure information is contained in Section III.G. The patient shall be charged the rate as specified in the FY 1999 reimbursable rates for an episode of care. The charges for elective cosmetic surgery are at the full reimbursement rate (designated as the "Other" rate) for inpatient per diem surgical care services in Section I.B., ambulatory procedure visits as contained in Section III.C, or the appropriate outpatient clinic rate in Sections II.A-K. The patient is responsible for the cost of the implant(s) and the prescribed cosmetic surgery rate. (Note: The implants and procedures used for the augmentation mammaplasty are in compliance with Federal Drug Administration guidelines.)

¹¹ Each regional lipectomy shall carry a separate charge. Regions include head and neck, abdomen, flanks, and hips.

¹² These procedures are inclusive in the minor skin lesions. However, CHAMPUS separates them as noted here. All charges shall be for the entire treatment, regardless of the number of visits required.

¹³ Dental service rates are based on a dental rate multiplier times the American Dental Association (ADA) code and the DoD established weight for that code.

¹⁴ Ambulance charges shall be based on hours of service in 15 minute increments. The rates listed in Section III.I are for 60 minutes or 1 hour of service. Providers shall calculate the charges based on the number of hours (and/or fractions of an hour) that the ambulance is logged out on a patient run. Fractions of an hour shall be rounded to the next 15 minute increment (e.g., 31 minutes shall be charged as 45 minutes).

¹⁵ Air in-flight medical care reimbursement charges are determined by the status of the patient (ambulatory or litter) and are per patient. The appropriate charges are billed only by the Air Force Global Patient Movement Requirement Center (GPMRC).

¹⁶ Observation Services are billed at either the hourly or daily charge. Begin counting when the patient is placed in the observation bed, and round to the nearest hour. The daily rate for full/third party, for example, would be $660 based on 24 hours of service. If a patient status changes to inpatient, the charges for observation services are added to the DRG assigned to the case and not billed separately. If a patient is released from Observation status and is sent to an APV, the charges for Observation services are not billed separately, but are added to the APV rate in order to recover all expenses.

1. Department of Health and Human Services

For the Department of Health and Human Services, Indian Health Service, effective October 1, 1998 and thereafter:

Hospital Care Inpatient Day

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OFFICE OF MANAGEMENT AND BUDGET

Cost of Hospital and Medical Care Treatment Furnished by the United States;
Certain Rates Regarding Recovery From Tortiously Liable Third Persons

By virtue of the authority vested in the President by Section 2(a) of P.L. 87-693 (76 Stat. 593; 42 U.S.C.2652), and delegated to the Director of the Office of Management and Budget by Executive Order No. 11541 of July 1, 1970 (35 Federal Register 10737), the two sets of rates outlined below are hereby established. These rates are for use in connection with the recovery, from tortiously liable third persons, of the cost of hospital and medical care and treatment furnished by the United States (Part 43, Chapter I, Title 28, Code of Federal Regulations) through three separate Federal agencies. The rates have been established in accordance with the requirements of OMB Circular A-25, requiring reimbursement of the full cost of all services provided. The rates are established as follows:

1. Department of Defense

The FY 1999 Department of Defense (DoD) reimbursement rates for inpatient, outpatient, and other services are provided in accordance with Section 1095 of title 10, United States Code. Due to size, the sections containing the Drug Reimbursement Rates (Section III.E) and the rates for Ancillary Services Requested by Outside Providers (Section III.F) are not included in this package. The Office of the Assistant Secretary of Defense (Health Affairs) will provide these rates upon request. The medical and dental service rates in this package (including the rates for ancillary services, prescription drugs or other procedures requested by outside providers) are effective October 1, 1998.

2. Health and Human Services

The sum of obligations for each cost center providing medical service is broken down into amounts attributable to inpatient care on the basis of the proportion of staff devoted to each cost center. Total inpatient costs and outpatient costs thus determined are divided by the relevant workload statistic (inpatient day, outpatient visit) to produce the inpatient and outpatient rates. In calculation of the rates, the Department's unfunded retirement liability cost and capital and equipment depreciation cost were incorporated to conform to requirements set forth in OMB Circular A-25. In addition, each cost center's obligations include obligations from certain other accounts, such as Medicare and Medicaid collections and Contract Health funds that were used to support direct program operations. Certain cost centers that primarily support workload outside of the directly operated hospitals or clinics (public health nursing, public health nutrition, health education) were excluded. These obligations are not a part of the traditional cost of hospital operations and do not contribute directly to the inpatient and outpatient visit workload. Overall, these rates reflect a more accurate indication of the cost of care in HHS facilities.

In addition, separate rates per inpatient day and outpatient visit were computed for Alaska and the rest of the United States. This gives proper weight to the higher cost of operating medical facilities in Alaska.

1. Department of Defense

For the Department of Defense, effective October 1, 1998 and thereafter:

Inpatient, Outpatient And Other Rates And Charge.
Inpatient Rates ^{1 2}

International military education per inpatient day Interagency& Other Federal Agency &Training (IMET) Other Sponsored Patients

A. Burn Center $2,538.00 $4,632.00 $4,952.00

B. Surgical Care Services
(Cosmetic Surgery) $1,236.00 $2,255.00 $2,411.00

C.All Other Inpatient Services (Based on Diagnosis Related Groups (DRG) ³)

1.FY99 Direct Care Inpatient Reimbursement Rates

Adjusted standard amount IMET Interagency Other (full/third party)

Large Urban $2,429.00 $4,552.00 $4,825.00

Other Urban/Rural $2,642.00 $5,413.00 $5,760.00

Overseas $2,989.00 $6,823.00 $7,234.00

2. Overview

The FY99 inpatient rates are based on the cost per DRG, which is the inpatient full reimbursement rate per hospital discharge weighted to reflect the intensity of the principal diagnosis, secondary diagnoses, procedures, patient age, etc. involved. The average cost per Relative Weighted Product (RWP) for large urban, other urban/rural, and overseas facilities will be published annually as an inpatient adjusted standardized amount (ASA) (see paragraph I.C.1. above). The ASA will be applied to the RWP for each inpatient case, determined from the DRG weights, outlier thresholds, and payment rules published annually for hospital reimbursement rates under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) pursuant to 32 CFR 199.14(a)(1), including adjustments for length of stay (LOS) outliers. The published ASAs will be adjusted for area wage differences and indirect medical education (IME) for the discharging hospital. An example of how to apply DoD costs to a DRG standardized weight to arrive at DoD costs is contained in paragraph I.C.3., below.

3. Example of Adjusted Standardized Amounts for Inpatient Stays

Figure 1 shows examples for a nonteaching hospital in a Large Urban Area.

a. The cost to be recovered is DoD's cost for medical services provided in the nonteaching hospital located in a large urban area. Billings will be at the third party rate.

b. DRG 020: Nervous System Infection Except Viral Meningitis. The RWP for an inlier case is the CHAMPUS weight of 2.9769. (DRG statistics shown are from FY 1997).

c. The DoD adjusted standardized amount to be charged is $4,825 (i.e., the third party rate as shown in the table).

d. DoD cost to be recovered at a nonteaching hospital with area wage index of 1.0 is the RWP factor (2.9769 ) in 3.b., above, multiplied by the amount ($4,825) in 3.c., above.

e. Cost to be recovered is $14,364.

FIGURE 1. THIRD PARTY BILLING EXAMPLES

DRG No. DRG Description DRG Weight Arithmetic Mean LOS Geometric Mean LOS Short Stay Threshold Long Stay Threshold

020 Nervous System Infection Except Viral Meningitis
2.9769
11.2
7.8
1
30

Hospital Location Area Wage Rate Index IME Adjustment Group ASA Applied ASA

Nonteaching Hospital Large Urban 1.0 1.0 $4,825.00 $4,825.00

Relative Weighted Product

Patient Length of Stay Days Above Threshold Inlier* Outlier** Total TPC amount***

#1 7 days 0 2.9769 0.0000 2.9769 $14,364

#2 21 days 0 2.9769 0.0000 2.9769 $14,364

#3 35 days 5 2.9769 0.6297 3.6066 $17,402

* DRG Weight

** Outlier calculation = 33 percent of per diem weight × number of outlier days

= .33 (DRG Weight/Geometric Mean LOS) × (Patient LOS - Long Stay Threshold)

= .33 (2.9769/7.8) × (35-30)

= .33 (.38165) × 5 (take out to five decimal places)

= .12594 × 5 (take out to five decimal places)

= .6297 (take out to four decimal places)

*** Applied ASA × Total RWP

II. Outpatient Rates ^{1 2} Per Visit

MEPRS code ⁴
Clinical service
International
military education
& training (IMET) Interagency & Other federal agency sponsored patients
Other (full/third party)

A. Medical Care

BAA Internal Medicine $104.00 $186.00 $198.00

BAB Allergy 48.00 86.00 92.00

BAC Cardiology 78.00 140.00 149.00

BAE Diabetic 57.00 102.00 108.00

BAF Endocrinology (Metabolism) 90.00 162.00 173.00

BAG Gastroenterology 114.00 205.00 219.00

BAH Hematology 145.00 260.00 277.00

BAI Hypertension 89.00 160.00 170.00

BAJ Nephrology 138.00 245.00 261.00

BAK Neurology 112.00 200.00 213.00

BAL Outpatient Nutrition 33.00 59.00 63.00

BAM Oncology 132.00 236.00 251.00

BAN Pulmonary Disease 118.00 211.00 225.00

BAO Rheumatology 84.00 151.00 160.00

BAP Dermatology 68.00 122.00 130.00

BAQ Infectious Disease 126.00 225.00 240.00

BAR Physical Medicine 74.00 133.00 142.00

BAS Radiation Therapy 91.00 164.00 174.00

B. Surgical Care

BBA General Surgery 164.00 295.00 314.00

BBB Cardiovascular and Thoracic Surgery 132.00 237.00 252.00

BBC Neurosurgery 188.00 337.00 359.00

BBD Ophthalmology 102.00 183.00 194.00

BBE Organ Transplant 239.00 429.00 457.00

BBF Otolaryngology 124.00 222.00 237.00

BBG Plastic Surgery 129.00 231.00 247.00

BBH Proctology 65.00 117.00 124.00

BBI Urology 125.00 224.00 239.00

BBJ Pediatric Surgery 91.00 163.00 174.00

C. Obstetrical and Gynecological (OB-GYN) Care

BCA Family Planning 45.00 81.00 87.00

BCB Gynecology 101.00 181.00 193.00

BCC Obstetrics 72.00 129.00 137.00

BCD Breast Cancer Clinic 171.00 307.00 327.00

D. Pediatric Care

BDA Pediatric 63.00 113.00 120.00

BDB Adolescent 60.00 108.00 115.00

BDC Well Baby 40.00 71.00 76.00

E. Orthopaedic Care

BEA Orthopaedic 118.00 212.00 226.00

BEB Cast 50.00 90.00 96.00

BEC Hand Surgery 61.00 109.00 116.00

BEE Orthotic Laboratory 60.00 108.00 115.00

BEF Podiatry 67.00 119.00 127.00

BEZ Chiropractic 24.00 42.00 45.00

F. Psychiatric and/or Mental Health Care

BFA Psychiatry 97.00 174.00 186.00

BFB Psychology 79.00 141.00 150.00

BFC Child Guidance 52.00 93.00 99.00

BFD Mental Health 105.00 188.00 201.00

BFE Social Work 77.00 137.00 146.00

BFF Substance Abuse 82.00 147.00 156.00

G. Family Practice/Primary Medical Care

BGA Family Practice 74.00 133.00 141.00

BHA Primary Care 75.00 134.00 143.00

BHB Medical Examination 66.00 118.00 126.00

BHC Optometry 48.00 86.00 91.00

BHD Audiology 27.00 49.00 52.00

BHE Speech Pathology 69.00 123.00 131.00

BHF Community Health 48.00 87.00 92.00

BHG Occupational Health 78.00 141.00 150.00

BHH TRICARE Outpatient 44.00 79.00 84.00

BHI Immediate Care 108.00 193.00 206.00

H. Emergency Medical Care

BIA Emergency Medical 114.00 205.00 218.00

I. Flight Medical Care

BJA Flight Medicine 103.00 185.00 197.00

J. Underseas Medical Care

BKA Underseas Medicine 35.00 63.00 67.00

K. Rehabilitative Services

BLA Physical Therapy 34.00 60.00 64.00

BLB Occupational Therapy 48.00 86.00 91.00

III. Other Rates And Charges ^{1 2} Per Visit

MEPRS Code ⁴

Clinical Service
International Military Education & Training (IMET) Interagency & Other Federal Agency Sponsored Patients
Other (full/third party)

FBI A. Immunization $13.00 $22.00 $24.00

DGC B. Hyperbaric Chamber ⁵ 191.00 343.00 366.00

C. Ambulatory Procedure Visit (APV) ⁶ 926.00 1,657.00 1,765.00

D. Family Member Rate (formerly Military Dependents Rate) 10.45 .......... ..........

E. Reimbursement Rates For Drugs Requested By Outside Providers ⁷

The FY 1999 drug reimbursement rates for drugs are for prescriptions requested by outside providers and obtained at a Military Treatment Facility. The rates are established based on the cost of the particular drugs provided. Final rule 32 CFR Part 220 eliminates the high cost ancillary services' dollar threshold and the associated term "high cost ancillary service." The phrase "high cost ancillary service" will be replaced with the phrase "ancillary services requested by an outside provider" on publication of final rule 32 CFR Part 220. The list of drug reimbursement rates is too large to include here. These rates are available on request from OASD (Health Affairs).

F. Reimbursement Rates for Ancillary Services Requested By Outside Providers ⁸

Final rule 32 CFR Part 220 eliminates the high cost ancillary services' dollar threshold and the associated term "high cost ancillary service." The phrase "high cost ancillary service" will be replaced with the phrase "ancillary services requested by an outside provider" on publication of final rule 32 CFR Part 220. The list of FY 1999 rates for ancillary services requested by outside providers and obtained at a Military Treatment Facility is too large to include here. These rates are available on request from OASD(Health Affairs).

G. Elective Cosmetic Surgery Procedures and Rates

Cosmetic Surgery Procedure International Classification Diseases (ICD-9) Current Procedural Terminology (CPT) ⁹
FY 1999 Charge ¹⁰ Amount of Charge

Mammaplasty 85.50, 85.32, 85.31 19325, 19324, 19318 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Mastopexy 85.60 19316 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Facial Rhytidectomy 86.82, 86.22 15824 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Blepharoplasty 08.70, 08.44 15820, 15821, 15822, 15823 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Mentoplasty (Augmentation/Reduction) 76.68, 76.67 21208, 21209 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Abdominoplasty 86.83 15831 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Lipectomy suction per region ¹¹ 86.83 15876, 15877, 15878, 15879 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Rhinoplasty 21.87, 21.86 30400, 30410 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Scar Revisions beyond CHAMPUS 86.84 15785 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Mandibular or Maxillary Repositioning 76.41 21194 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Minor Skin Lesions ¹² 86.30 15785 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Dermabrasion 86.25 15780 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Hair Restoration 86.64 15775 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Removing Tattoos 86.25 15780 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Chemical Peel 86.24 15790 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Arm/Thigh Dermolipectomy 86.83 15839 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

Brow Lift 86.3 15839 Inpatient Surgical Care Per Diem
Or
APV or applicable Outpatient Clinic Rate (^{a b c})

H. Dental Rate ¹³ Per Procedure

MEPRS Code ⁴
Clinical Service
International Military Education & Training (IMET) Interagency & Other Federal Agency Sponsored Patients
Other (full/third party)

Dental Services, ADA code and DoD established weight $56.00 $101.00 $108.00

I. Ambulance Rate ¹⁴ Per Visit

MEPRS Code ⁴
Clinical Service
International Military Education & Training (IMET) Interagency & Other Federal Agency Sponsored Patients Other (full/third party)

FEA Ambulance $56.00 $101.00 $107.00

J. Ancillary Services Requested by an Outside Provider ⁸ Per Procedure

MEPRS Code ⁴
Clinical Service
International Military Education & Training (IMET) Interagency & Other Federal Agency Sponsored Patients
Other (full/third party)

Laboratory procedures requested by an outside provider CPT '98 Weight Multiplier $10.00 $17.00 $18.00

Radiology procedures requested by an outside provider CP '98 Weight Multiplier 25.00 45.00 48.00

Cardiology procedures requested by an outside provider CPT '98 Weight Multiplier 17.00 31.00 33.00

K. AirEvac Rate ¹⁵ Per Visit

MEPRS Code ⁴
Clinical Service
International Military Education & Training (IMET) Interagency & Other Federal Agency Sponsored Patients
Other (full/third party)

AirEvac Services - Ambulatory $90.00 $161.00 $172.00

AirEvac Services - Litter 256.00 459.00 489.00

Observation Rate ¹⁶ Per hour

MEPRS Code ⁴
Clinical Service
International Military Education & Training (IMET) Interagency & Other Federal Agency Sponsored Patients
Other (full/third party)

Observation Services Hour $14.50 $25.83 $27.50

Notes on Cosmetic Surgery Charges

^a Per diem charges for inpatient surgical care services are listed in Section I.B. (See notes 9 through 11, below, for further details on reimbursable rates.)

General Medical Care:
Alaska	$1,798
Rest of the United States	1,049

Outpatient Medical Treatment

Outpatient Visit:

Alaska $360

Rest of the United States 210

For the period beginning October 1, 1998, the rates prescribed herein superseded those established by the Director of the Office of Management and Budget October 31, 1997 (61 FR 56360).

Jacob Lew
Director, Office of Management and Budget

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