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December 21, 2020
Adjusted Standardized Amounts for All Areas
This table provides the adjusted standardized amounts and the cost share per diem for beneficiaries other than dependents of active duty members.The adjusted standardized amounts are effective for discharges occurring on or after January 1, 2021, through December 31, 2021.
The cost share per diem is effective for inpatient days of care occurring on or after January 1, 2021, through December 31, 2021. Cost share per diem for beneficiaries other than dependents of active duty members: $1,034.00.
| Hospital Type |
Wage Index <=1 |
Wage Index >1 |
| Adjusted Standardized Amount |
$7,273.32 |
$7,273.32
|
| Labor Portion |
$4,509.46 |
$4,967.68 |
| Non Labor Portion |
$2,763.86 |
$2,305.64 |
CY 2021 TRICARE/CHAMPUS DRG Weights and Threshold Summary
Download the 2021 Weights
This document also includes the arithmetic and geometric average lengths of stay and outlier thresholds for all CHAMPUS DRGs. These amounts are effective for discharges on or after January 1, 2021, through December 31, 2021.
Notes:
- * = low volume DRG with fewer than 10 cases. The Medicare weights and LOS are used for these DRGs.
- # = PM-DRGs with fewer than 10 cases. An average weight over the past 5 years were used for these DRGs.
- w cc = with Complications and Comorbidities.
- w/o cc = without Complications or Comorbidities
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Last Updated: July 11, 2023