TRICARE Increases Payment for Dipstick Urinalysis

Family physicians who participate in TRICARE, the U.S. military health plan, will be pleased with a bit of good news about the plan's recent change in its payment policy for dipstick urinalysis.

Retroactive to Oct. 1, 2008, CPT codes 81000 through 81003 for urinalysis will be separately reimbursed by all TRICARE managed care support contractors when billed with an evaluation and management, or E/M, CPT code. Physicians should ask their TRICARE contractors if they need to resubmit claims filed last fall.

For years, the AAFP has argued that TRICARE's practice of "bundling" some services -- such as a dipstick test with an E/M visit -- denied family physicians full and proper payment.

Maj. Gen. Elder Granger, deputy director of TRICARE management activity, approved the change in policy after meeting with AAFP President Ted Epperly, M.D., of Boise, Idaho, last September.

At that meeting, held at the office of the Assistant Secretary of Defense for Health Affairs in Falls Church, Va., Epperly pointed out that Medicare didn't bundle the two services and, in fact, paid physicians separately for an E/M code and a dipstick procedure.

That line of reasoning apparently resonated with Granger. In a Feb. 6 letter to Epperly notifying him of the change, Granger said, "As you know, TRICARE is required by statute to use, to the extent practicable, the same reimbursement rules that apply to Medicare payments for similar services. Thank you for assisting us to ensure compliance with this requirement."

TRICARE still needs to address other issues -- such as low payment rates, limited network providers and a cumbersome referral process -- to make its program more physician-friendly, Epperly recently told AAFP News Now.

"This is a great first step toward making TRICARE participation more favorable to our members," said Epperly. "I applaud Maj. Gen. Granger for his actions to resolve this problem and look forward to working with him and TRICARE to help settle the Academy's remaining concerns."