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UBO Rates Overview

The UBO billing rates are based on TRICARE allowable charges and are used to determine charges for outpatient, inpatient, dental, cosmetic surgery, and pharmacy services. Outpatient rates are the charges for professional and institutional health care services provided by Military Treatment Facilities. Inpatient rates are used when billing for inpatient medical services at MTFs. Each MTF providing inpatient care has its own applied Adjusted Standardized Amount. Pharmacy rates are based on TRICARE allowable charges, average wholesale price, or prime vendor program prices listed for the national drug codes and are used to set pharmacy rates for pharmaceuticals and approved drugs.

UBO rates differ slightly from the standard TRICARE rates. UBO rates are specifically formatted for military billing systems, and include charges for additional services not reimbursed by TRICARE.

The Assistant Secretary of Defense for Health Affairs approved the implementation of CY 2021 Outpatient Medical Dental and Cosmetic Procedure Reimbursement Rates for direct care received at military treatment facilities as of July 1, 2020. These rates are used to determine:

Charges for medical and dental services provided on an outpatient basis
Ambulatory services
Inpatient cosmetic surgery services

These rates were released in accordance with U.S.C. Title 10, and will remain in effect until further notice.

The Calendar Year 2022 Inpatient Rates link will be updated shortly. These rates are used to determine charges for inpatient professional and institutional health care services provided in MTFs under the Defense Health Program.

UBO rates are published online in accordance with Executive Order 13410 (August 2006) to promote health care transparency relating to quality and cost.

Mapping Tables

UBO billing systems use rate files in conjunction with several mapping tables that direct the billing systems to the appropriate rate file for any given procedure. These mapping tables also specify the billing form for each procedure and provide appropriate revenue centers and modifiers for each procedure. The major mapping files include:

Calendar Year	Mapping Tables
2023	DMIS ID to CMAC Locality Table Revenue Mapping Table ABACUS Mapping Table Modifier Mapping Table
2022	DMIS ID to CMAC Locality Table Revenue Mapping Table ABACUS Mapping Table Modifier Mapping Table
2021	DMIS ID to CMAC Locality Table Revenue Mapping Table ABACUS Mapping Table Modifier Mapping Table
2020	DMIS ID to CMAC Locality Table Revenue Mapping Table ABACUS Mapping Table (Out-of-Cycle) Modifier Mapping Table
2019	DMIS ID to CMAC Locality Table Revenue Mapping Table ABACUS Mapping Table Modifier Mapping Table
2018	DMIS ID to CMAC Locality Table Revenue Mapping Table ABACUS Mapping Table Modifier Mapping Table
2017	DMIS ID to CMAC Locality Table Revenue Mapping Table ABACUS Mapping Table Modifier Mapping Table
2016	DMIS ID to CMAC Locality Table Revenue Mapping Table ABACUS Mapping Table Modifier Mapping Table
2015	DMIS ID to CMAC Locality Table Revenue Mapping Table TPOCS Mapping Table Modifier Mapping Table
2014	DMIS ID to CMAC Locality Table Revenue Mapping Table TPOCS Mapping Table Modifier Mapping Table