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DEFENSE Hf.ALTH AGEN(:l "

MB&RS

OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE HEAL TH AFFAIRS

16401 EASTCENTRETECH PARKWAY AURORA, CO 80011 -9066

CHANGE 173 6010.57-M OCTOBER 19, 2016

PUBLICATIONS SYSTEM CHANGE TRANSMITTAL FOR TRICARE POLICY MANUAL (TPM), FEBRUARY 2008

The Defense Health Agency has authorized the following addition(s)/revision(s).

CHANGE TITLE: CARDIAC REHABILITATION FOR THE TREATMENT OF CONGESTIVE HEART FAILURE AND STABLE CHRONIC HEART FAILURE

CONREO: 18071

PAGE CHANGE(Sl: See page 2.

SUMMARY OF CHANGE{Sl: This change adds Congestive Heart Failure (CHF) and Stable Chronic Heart Failure (SCHF) to the cardiac rehabilitation services treatment list, and confirms the effective dates for CHF/SCHF, in addition to myocardial infarction, coronary artery bypass graft, coronary angioplasty, percutaneous transluminal coronary angioplasty, and chronic stable angina, heart valve surgery and heart transplants, to include heart-lung.

EFFECTIVE DATE: 1. October 9, 1987. Myocardial infarction, coronary artery bypass graft, coronary angioplasty, percutaneous transluminal coronary angioplasty, and chronic angina. 2. December 1, 1991. Heart valve surgery and heart transplants, to include heart-lung. 3. July 18, 2016. Congestive Heart Failure/Stable Chronic Heart Failure.

IMPLEMENTATION DATE: November 21, 2016.

FAZZI NI.ANN. N OREEN .119980 2271 (/ Ann N. Fazzini

Digitally signed by FAZZINl.ANN.NOREEN.119 9802271 Date:.2016.10.18 12:02:40 -06'00'

Team Chief, Medical Benefits & Reimbursement Section (MB&RS) Defense Health Agency (DHA)

WHEN PRESCRIBED ACTION HAS BEEN TAKEN, FILE THIS TRANSMITTAL WITH BASIC DOCUMENT.

CHANGE 1736010.57-MOCTOBER 19, 2016

2

REMOVE PAGE(S) INSERT PAGE(S)

CHAPTER 7

Section 11.1, pages 1 and 2 Section 11.1, pages 1 and 2

APPENDIX A

pages 5 through 26, 29, and 30 pages 5 through 26, 29, and 30

1

TRICARE Policy Manual 6010.57-M, February 1, 2008Medicine

Chapter 7 Section 11.1

Cardiac Rehabilitation

Issue Date: November 1, 1983Authority: 32 CFR 199.4(e)(18)

1.0 CPT1 PROCEDURE CODE RANGE

93797 - 93798

2.0 DESCRIPTION

Cardiac rehabilitation is the process by which individuals are restored to their optimal physical, medical, and psychological status, after a cardiac event. Cardiac rehabilitation is often divided into three phases. Phase I begins during inpatient hospitalization and is managed by the patient’s personal physician. Phase II is a medically supervised outpatient program which begins following discharge. Phase III is a lifetime maintenance program emphasizing continuation of physical fitness with periodic follow-up. Each phase includes an exercise component, patient education, and risk factor modification. There may be considerable variation in program components, intensity and duration.

3.0 POLICY

3.1 Cardiac rehabilitation services are cost-shared on an inpatient or outpatient basis for services and supplies provided in connection with a cardiac rehabilitation program when ordered by a physician and provided as treatment for patients who have experienced the following cardiac events within the preceding 12 months:

• Myocardial infarction.• Coronary artery bypass graft.• Coronary angioplasty.• Percutaneous transluminal coronary angioplasty.• Chronic stable angina.• Heart valve surgery.• Heart transplants, to include heart-lung.• Congestive Heart Failure (CHF)/Stable Chronic Heart Failure (SCHF).

3.2 Payable benefits include separate allowance for the initial evaluation and testing. Outpatient treatment following the initial intake evaluation and testing is limited to a maximum of 36 sessions per cardiac event, usually provided three sessions per week for 12 weeks. Patients diagnosed with chronic stable angina and CHF/SCHF are limited to one treatment episode (36 sessions) in a calendar year.

1 CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

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4.0 EXCLUSION

Phase III cardiac rehabilitation for lifetime maintenance performed at home or in medically unsupervised settings.

5.0 EFFECTIVE DATES

5.1 Effective October 9, 1987, for myocardial infarction, coronary artery bypass graft, coronary angioplasty, percutaneous transluminal coronary angioplasty, and chronic stable angina.

5.2 Effective December 1, 1991, for heart valve surgery and heart transplants, to include heart-lung.

5.3 Effective July 18, 2016, for CHF/SCHF.

- END -

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Acronyms And Abbreviations

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CAD Coronary Artery DiseaseCAF Central Adjudication FacilityCAH Critical Access HospitalCAMBHC Comprehensive Accreditation Manual for Behavioral Heath CareCAP Competitive Acquisition ProgramCAP/DME Capital and Direct Medical EducationCAPD Continuous Ambulatory Peritoneal DialysisCAPP Controlled Access Protection ProfileCAQH Council for Affordable Quality HealthCARC Claim Adjustment Reason CodeCAS Carotid Artery StenosisCAT Computerized Axial TomographyCB Consolidated BillingCBC Cypher Block ChainingCBE Clinical Breast ExaminationCBHCO Community-Based Health Care OrganizationsCBL Commercial Bill of LadingCBP Competitive Bidding ProgramCBSA Core Based Statistical AreaCC Common Criteria

Convenience ClinicCriminal Control (Act)

CC&D Catastrophic Cap and DeductibleCCCT Clomiphene Citrate Challenge TestCCD Corporate Credit or DebitCCDD Catastrophic Cap and Deductible DataCCEP Comprehensive Clinical Evaluation ProgramCCN Case Control NumberCCPD Continuous Cycling Peritoneal DialysisCCR Cost-To-Charge RatioCCSW Certified Clinical Social WorkerCCTP Custodial Care Transitional PolicyCD Compact 9DiscCDC Centers for Disease Control and PreventionCDCF Central Deductible and Catastrophic Cap FileCDD Childhood Disintegrative DisorderCDH Congenital Diaphragmatic HerniaCD-I Compact Disc- InteractiveCDR Clinical Data RepositoryCDRL Contract Data Requirements ListCD-ROM Compact Disc - Read Only MemoryCDT Current Dental Terminology

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CEA Carotid EndarterectomyCEIS Corporate Executive Information SystemCEO Chief Executive OfficerCEOB CHAMPUS Explanation of BenefitsCES Cranial Electrotherapy StimulationCF Conversion Factor

Cystic FibrosisCFO Chief Financial OfficerCFR Code of Federal RegulationsCFRD Cystic Fibrosis-Related DiabetesCFS Chronic Fatigue SyndromeCGMS Continuous Glucose Monitoring SystemCHAMPUS Civilian Health and Medical Program of the Uniformed ServicesCHAMPVA Civilian Health and Medical Program of the Department of Veteran AffairsCHBC Criminal History Background CheckCHBR Criminal History Background ReviewCHC Civilian Health CareCHCBP Continued Health Care Benefits ProgramCHCS Composite Health Care SystemCHEA Council on Higher Education AccreditationCHF Congestive Heart FailureCHKT Combined Heart-Kidney TransplantCHOP Children’s Hospital of PhiladelphiaCI CounterintelligenceCIA Central Intelligence AgencyCID Central Institute for the DeafCIF Central Issuing Facility

Common Intermediate FormatCIO Chief Information OfficerCIPA Classified Information Procedures ActCJCSM Chairman of the Joint Chiefs of Staff ManualCL Confidentiality Level (Classified, Public, Sensitive)CLIA Clinical Laboratory Improvement AmendmentCLIN Contract Line Item NumberCLKT Combined Liver-Kidney TransplantCLL Chronic Lymphocytic LeukemiaCM Case ManagementCMAC CHAMPUS Maximum Allowable ChargeCMHC Community Mental Health CenterCML Chronic Myelogenous LeukemiaCMN Certificate(s) of Medical NecessityCMO Chief Medical Officer

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CMP Civil Money PenaltyCMR Cardiovascular Magnetic ResonanceCMS Centers for Medicare and Medicaid ServicesCMVP Cryptographic Module Validation ProgramCNM Certified Nurse MidwifeCNS Central Nervous System

Clinical Nurse SpecialistCO Contracting OfficerCOB Close of Business

Coordination of BenefitsCOBC Coordination of Benefits ContractorCOBRA Consolidated Omnibus Budget Reconciliation Act COCO Contractor Owned-Contractor OperatedCOE Common Operating EnvironmentCONUS Continental United StatesCOO Chief Operating OfficerCOOP Continuity of Operations PlanCOPA Council on Postsecondary AccreditationCOPD Chronic Obstructive Pulmonary DiseaseCOR Contracting Officer’s RepresentativeCORE Committee on Operating Rules for Information ExchangeCORF Comprehensive Outpatient Rehabilitation FacilityCORPA Commission on Recognition of Postsecondary AccreditationCOTS Commercial-off-the-shelfCP Cerebral PalsyCPA Certified Public AccountantCPE Contract Performance EvaluationCPI Consumer Price IndexCPI-U Consumer Price Index - Urban (Wage Earner)CPNS Certified Psychiatric Nurse SpecialistsCPR CAC PIN ResetCPT Chest Physiotherapy

Current Procedural TerminologyCPT-4 Current Procedural Terminology, 4th EditionCQM Clinical Quality ManagementCQMP Clinical Quality Management ProgramCQMP AR Clinical Quality Management Program Annual ReportCQS Clinical Quality StudiesCRM Contract Resource Management (Directorate)CRNA Certified Registered Nurse AnesthetistCRP Canalith Repositioning ProcedureCRS Cytoreductive SurgeryCRSC Combat-Related Special Compensation

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CRT Computer Remote TerminalCSA Clinical Support AgreementCSE Communications Security Establishment (of the Government of Canada)CSP Corporate Service Provider

Critical Security ParameterCST Central Standard TimeCSU Channel Sending UnitCSV Comma-Separated ValueCSW Clinical Social WorkerCT Central Time

Computerized TomographyCTA Composite Tissue Allotransplantation

Computerized Tomography AngiographyCTC Computed Tomographic ColonographyCTCL Cutaneous T-Cell LymphomaCTEP Cancer Therapy Evaluation ProgramCTLN1 Citrullinemia Type 1CTX Corporate Trade ExchangeCUI Controlled Unclassified InformationCUC Chronic Ulcerative ColitisCVAC CHAMPVA CenterCVS Contractor Verification SystemCY Calendar YearDAA Designated Approving AuthorityDAO Defense Attache OfficesDBA Doing Business AsDBN DoD Benefits NumberDC Direct CareDCAA Defense Contract Audit AgencyDCAO Debt Collection Assistance OfficerDCID Director of Central Intelligence DirectiveDCII Defense Clearance and Investigation IndexDCIS Defense Criminal Investigative Service

Ductal Carcinoma In SituDCN Document Control NumberDCP Data Collection PeriodDCPE Disability Compensation and Pension ExaminationDCR Developed Character ReferenceDCS Duplicate Claims SystemDCSI Defense Central Security IndexDCWS DEERS Claims Web ServiceDD (Form) Department of Defense (Form)DDAS DCII Disclosure Accounting System

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DDD Degenerative Disc DiseaseDDP Dependent Dental PlanDDS DEERS Dependent SuffixDE Durable EquipmentDECC Defense Enterprise Computing CenterDED Dedicated Emergency DepartmentDEERS Defense Enrollment Eligibility Reporting SystemDELM Digital Epiluminescence MicroscopyDENC Detailed Explanation of Non-ConcurrenceDepSecDef Deputy Secretary of DefenseDES Data Encryption Standard

Disability Evaluation SystemDFAS Defense Finance and Accounting ServiceDG Diagnostic GroupDGH Denver General HospitalDHA Defense Health AgencyDHA-GL Defense Health Agency-Great Lakes (formerly Military Medical Support Office

(MMSO))DHHS Department of Health and Human ServicesDHP Defense Health ProgramDHS Department of Homeland SecurityDIA Defense Intelligence AgencyDIACAP DoD Information Assurance Certification And Accreditation ProcessDII Defense Information Infrastructure DIS Defense Investigative ServiceDISA Defense Information System AgencyDISCO Defense Industrial Security Clearance OfficeDISN Defense Information Systems NetworkDISP Defense Industrial Security ProgramDITSCAP DoD Information Technology Security Certification and Accreditation ProcessDLAR Defense Logistics Agency RegulationDLE Dialyzable Leukocyte Extract0DLI Donor Lymphocyte InfusionDM Disease ManagementDMDC Defense Manpower Data CenterDME Durable Medical EquipmentDMEPOS Durable medical equipment, prosthetics, orthotics, and suppliesDMI DMDC Medical InterfaceDMIS Defense Medical Information SystemDMIS-ID Defense Medical Information System Identification (Code)DMLSS Defense Medical Logistics Support SystemDMR Direct Member Reimbursement

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DMZ Demilitarized ZoneDNA Deoxyribonucleic AcidDNA-HLA Deoxyribonucleic Acid - Human Leucocyte AntigenDNACI DoD National Agency Check Plus Written InquiriesDO Doctor of Osteopathy

Operations DirectorateDOB Date of BirthDOC Dynamic Orthotic Cranioplasty (Band)DoD Department of DefenseDoD AI Department of Defense Administrative InstructionDoDD Department of Defense DirectiveDoDI Department of Defense InstructionDoDIG Department of Defense Inspector GeneralDoDM Department of Defense ManualDoD P&T Department of Defense Pharmacy and Therapeutics (Committee)DOE Department of EnergyDOEBA Date of Earliest Billing ActionDOES DEERS Online Enrollment SystemDOHA Defense Office of Hearings and AppealsDOJ Department of JusticeDOLBA Date of Latest Billing ActionDOS Date Of ServiceDP Designated ProviderDPA Differential Power AnalysisDPCLO Defense Privacy and Civil Liberties OfficeDPI Designated Providers IntegratorDPO DEERS Program OfficeDPPO Designated Provider Program OfficeDRA Deficit Reduction ActDREZ Dorsal Root Entry ZoneDRG Diagnosis Related GroupDRPO DEERS RAPIDS Program OfficeDRS Decompression Reduction StabilizationDSA Data Sharing AgreementDSAA Data Sharing Agreement Application

Defense Security Assistance AgencyDSC DMDC Support CenterDSCC Data and Study Coordinating CenterDS Logon DoD Self-Service LogonDSM Diagnostic and Statistical Manual of Mental DisordersDSM-III Diagnostic and Statistical Manual of Mental Disorders, Third EditionDSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

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DSMC Data and Safety Monitoring CommitteeDSMO Designated Standards Maintenance OrganizationDSMT Diabetes Self-Management TrainingDSO DMDC Support OfficeDSPOC Dental Service Point of ContactDSU Data Sending UnitDTF Dental Treatment FacilityDTM Directive-Type MemorandumDTR Derived Test RequirementsDTRO Director, TRICARE Regional OfficeDUA Data Use AgreementDVA Department of Veterans AffairsDVAHCF Department of Veterans Affairs Health Care FinderDVD Digital Versatile Disc (formerly Digital Video Disc)DVD-R Digital Versatile Disc-RecordableDWR DSO Web RequestDx DiagnosisDXA Dual Energy X-Ray AbsorptiometryE-ID Early IdentificationE-NAS Electronic Non-Availability Statemente-QIP Electronic Questionnaires for Investigations ProcessingE&M Evaluation & ManagementE2R Enrollment Eligibility ReconciliationEACH Essential Access Community HospitalEAL Common Criteria Evaluation Assurance LevelEAP Employee-Assistance Program

Ethandamine phosphateEBC Enrollment Based CapitationECA External Certification AuthorityECAS European Cardiac Arrhythmia SocietyECG ElectrocardiogramECHO Extended Care Health OptionECT Electroconvulsive TherapyED Emergency DepartmentEDC Error Detection CodeEDI Electronic Data Information

Electronic Data InterchangeEDIPI Electronic Data Interchange Person IdentifierEDIPN Electronic Data Interchange Person NumberEDI_PN Electronic Data Interchange Patient NumberEEG ElectroencephalogramEEPROM Erasable Programmable Read-Only Memory

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EFD Energy Flux DensityEFM Electronic Fetal MonitoringEFMP Exceptional Family Member ProgramEFP Environmnetal Failure ProtectioneFRC Electronic Federal Records CenterEFT Electronic Funds Transfer

Environmental Failure TestingEGHP Employer Group Health PlanE/HPC Enrollment/Health Plan CodeEHHC ECHO Home Health Care

Extended Care Health Option Home Health CareEHP Employee Health ProgramEHRA European Heart Rhythm AssociationEIA Educational Interventions for Autism Spectrum DisordersEID Early Identification

Enrollment Information for DentalEIDS Executive Information and Decision SupportEIIP External Insulin Infusion PumpEIN Employer Identification NumberEIP External Infusion PumpEKG ElectrocardiogramELN Element Locator NumberELISA Enzyme-Linked Immunoabsorbent AssayE/M Evaluation and ManagementEMC Electronic Media Claim

Enrollment Management ContractorEMDR Eye Movement Desensitization and ReprocessingEMG ElectromyogramaeMSM Enhanced Multi-Service MarketEMTALA Emergency Medical Treatment & Active Labor ActENTNAC Entrance National Agency CheckEOB Explanation of BenefitsEOBs Explanations of BenefitsEOC Episode of CareEOE Evoked Otoacoustic EmissionEOG Electro-oculogramEOMB Explanation of Medicare BenefitsEOP Explanation of PaymentePHI electronic Protected Health InformationEPO Erythropoietin

Exclusive Provider OrganizationEPR EIA Program ReportEPROM Erasable Programmable Read-Only Memory

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ER Emergency RoomERA Electronic Remittance AdviceERISA Employee Retirement Income and Security Act of 1974ESRD End Stage Renal DiseaseEST Eastern Standard TimeESWT Extracorporeal Shock Wave TherapyET Eastern TimeETIN Electronic Transmitter Identification NumberEWPS Enterprise Wide Provider SystemEWRAS Enterprise Wide Referral and Authorization SystemF&AO Finance and Accounting Office(r)FAI Femoroacetabular ImpingementFAP Familial Adenomatous PolyposisFAR Federal Acquisition RegulationsFASB Federal Accounting Standards BoardFBI Federal Bureau of InvestigationFCC Federal Communications CommissionFCCA Federal Claims Collection ActFDA Food and Drug AdministrationFDB First Data BankFDL Fixed Dollar LossFed Federal Reserve BankFEHBP Federal Employee Health Benefit ProgramFEL Familial Erythrophagocytic LymphohistiocytosisFEV1 Forced Expiratory VolumeFFM Foreign Force MemberFHL Familial Hemophagocytic LymphohistiocytosisFI Fiscal IntermediaryFIPS Federal Information Processing Standards (or System)FIPS PUB FIPS PublicationFISH Fluorescence In Situ HybridizationFISMA Federal Information Security Management ActFL Form LocatorFMCRA Federal Medical Care Recovery ActFMRI Functional Magnetic Resonance ImagingFOBT Fecal Occult Blood TestingFOC Full Operational CapabilityFOIA Freedom of Information ActFOUO For Official Use OnlyFPO Fleet Post OfficeFQHC Federally Qualified Health Center

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FR Federal RegisterFrozen Records

FRC Federal Records CenterFSH Follicle Stimulating HormoneFSO Facility Security OfficerFTC Federal Trade CommissionFTE Full Time EquivalentFTP File Transfer ProtocolFX Foreign Exchange (lines)FY Fiscal YearGAAP Generally Accepted Accounting PrinciplesGAF Geographic Adjustment FactorGAO General Accounting OfficeGDC Guglielmi Detachable CoilGFE Government Furnished EquipmentGHP Group Health PlanGHz GigahertzGIFT Gamete Intrafallopian TransferGIQD Government Inquiry of DEERSGP General PractitionerGPCI Geographic Practice Cost IndexGTMCPA General Temporary Military Contingency Payment AdjustmentH/E Health and EnvironmentHAC Health Administration Center

Hospital Acquired ConditionHAVEN Home Assessment Validation and EntryHBA Health Benefits AdvisorHBO Hyperbaric Oxygen TherapyHCC Health Care CoverageHCDP Health Care Delivery ProgramHCF Health Care FinderHCFA Health Care Financing AdministrationHCG Human Chorionic GonadotropinHCIL Health Care Information LineHCM Hypertrophic CardiomyopathyHCO Healthcare Operations DivisionHCP Health Care ProviderHCPC Healthcare Common Procedure Code (formerly HCFA Common Procedure Code)HCPCS Healthcare Common Procedure Coding System (formerly HCFA Common

Procedure Coding System)HCPR Health Care Provider RecordHCSR Health Care Service RecordHDC High Dose Chemotherapy

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HDC/SCR High Dose Chemotherapy with Stem Cell RescueHDE Humanitarian Device ExemptionHDGC Hereditary Diffuse Gastric CancerHDL Hardware Description LanguageHDR High Dose RadiationHEAR Health Enrollment Assessment ReviewHEDIS Health Plan Employer Data and Information SetHE ESWT High Energy Extracorporeal Shock Wave TherapyHepB-Hib Hepatitis B and Hemophilus influenza BHH Home HealthHHA Home Health AgencyHHA PPS Home Health Agency Prospective Payment SystemHHC Home Health CareHHC/CM Home Health Care/Case ManagementHHRG Home Health Resource GroupHHS Health and Human ServicesHI Health InsuranceHIAA Health Insurance Association of AmericaHIC Health Insurance CarrierHICN Health Insurance Claim NumberHINN Hospital-Issued Notice Of NoncoverageHINT Hearing in Noise TestHIPAA Health Insurance Portability and Accountability Act (of 1996)HIPEC Hyperthermic Intraperitoneal ChemotherapyHIPPS Health Insurance Prospective Payment SystemHIQH Health Insurance Query for Health AgencyHIT Health Information TechnologyHITECH Health Information Technology for Economic and Clinical HealthHIV Human Immunodeficiency VirusHL7 Health Level 7HLA Human Leukocyte AntigenHMAC Hash-Based Message Authentication CodeHMO Health Maintenance OrganizationHNPCC Hereditary Non-Polyposis Colorectal CancerHOPD Hospital Outpatient DepartmentHPA&E Health Program Analysis & EvaluationHPSA Health Professional Shortage AreaHPV Human Papilloma VirusHRA Health Reimbursement ArrangementHRG Health Resource GroupHRS Heart Rhythm Society

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HRT Heidelberg Retina TomographHormone Replacement Therapy

HSCRC Health Services Cost Review CommissionHSWL Health, Safety and Work-LifeHTML HyperText Markup LanguageHTTP HyperText Transfer (Transport) ProtocolHTTPS Hypertext Transfer (Transport) Protocol SecureHUAM Home Uterine Activity MonitoringHUD Humanitarian Use DeviceHUS Hemolytic Uremic SyndromeHVPT Hyperventilation Provocation TestI&OD Infrastructure & Operations DivisionIA Information AssuranceIATO Interim Approval to OperateIAVA Information Assurance Vulnerability AlertIAVB Information Assurance Vulnerability BulletinIAVM Information Assurance Vulnerability ManagementIAW In accordance withIBD Inflammatory Bowel DiseaseIC Individual Consideration

Integrated CircuitICASS International Cooperative Administrative Support ServicesICD Implantable Cardioverter DefibrillatorICD-9-CM International Classification of Diseases, 9th Revision, Clinical ModificationICD-10-CM International Classification of Diseases, 10th Revision, Clinical ModificationICD-10-PCS International Classification of Diseases, 10th Revision, Procedure Coding SystemICF Intermediate Care FacilityICMP Individual Case Management ProgramICMP-PEC Individual Case Management Program For Persons With Extraordinary ConditionsICN Internal Control NumberICSP Individual Corporate Services ProviderID Identification

IdentifierIDB Intradiscal BiacuplastyIDD Internal or Intervertebral Disc DecompressionIDE Investigational Device Exemption

Investigational DeviceIDEA Individuals with Disabilities Education ActIDES Integrated Disability Evaluation SystemIDET Intradiscal Electrothermal TherapyIDME Indirect Medical EducationIdP Identity ProtectionIDTA Intradiscal Thermal Annuloplasty

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IE Interface EngineInternet Explorer

IEA Intradiscal Electrothermal AnnuloplastyIEP Individualized Educational ProgramIFC Interim Final Rule with commentIFR Interim Final RuleIFSP Individualized Family Service PlanIG Implementation GuidanceIgA Immunoglobulin AIGCE Independent Government Cost EstimateIHC ImmunohistochemistryIHI Institute for Healthcare ImprovementIHS Indian Health ServiceIIHI Individually Identifiable Health InformationIIP Implantable Infusion PumpIM Information Management

Instant Message/MessagingIntramuscular

IMRT Intensity Modulated Radiation TherapyIND Investigational New DrugsINR International Normalized Ratio

Intramuscular International Normalized RatioINS Immigration and Naturalization ServiceIOC Initial Operational CapabilityIOD Interface Operational DescriptionIOLs Intraocular LensesIOM Internet Only ManualIOP Intraocular PressureIORT Intra-Operative Radiation TherapyIP InpatientIPC Information Processing Center (outdated term, see SMC)IPHC Intraperitoneal Hyperthermic ChemotherapyIPN Intraperitoneal NutritionIPP In-Person ProofingIPPS Inpatient Prospective Payment SystemIPS Individual Pricing SummaryIPSF Inpatient Provider Specific FileIPSEC Secure Internet ProtocolIQ Intelligence QuotientIQM Internal Quality ManagementIRB Institutional Review BoardIRF Inpatient Rehabilitation FacilityIRR Individual Ready Reserve

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IRS Internal Revenue ServiceIRTS Integration and Runtime SpecificationIS Information SystemISN Investigation Schedule NoticeISO International Standard OrganizationISP Internet Service ProviderIT Information TechnologyITSEC Information Technology Security Evaluation CriteriaIV Initialization Vector

IntravenousIVD In Vitro Diagnostic

Ischemic Vascular DiseaseIVF In Vitro FertilizationJC Joint Commission (formerly Joint Commission on Accreditation of Healthcare

Organizations (JCAHO))JCAHO Joint Commission on Accreditation of Healthcare OrganizationsJCIH Joint Committee on Infant HearingJCOS Joint Chiefs of StaffJFTR Joint Federal Travel RegulationsJNI Japanese National InsuranceJTF-GNO Joint Task Force for Global Network OperationsJUSDAC Joint Uniformed Services Dental Advisory CommitteeJUSMAC Joint Uniformed Services Medical Advisory CommitteeJUSPAC Joint Uniformed Services Personnel Advisory CommitteeKB Knowledge BaseKO Contracting OfficerLAA Limited Access AuthorizationLAC Local Agency CheckLAK Lymphokine-Activated KillerLAN Local Area NetworkLASER Light Amplification by Stimulated Emission of RadiationLCD Local Coverage DeterminationLCF Long-term Care FacilityLCIS Lobular Carcinoma In SituLDL Low Density LipoproteinLDLT Living Donor Liver TransplantationLDR Low Dose RateLDT Laboratory Developed TestLE ESWT Low Energy Extracorporeal Shock Wave TherapyLGS Lennox-Gastaut SyndromeLH Luteinizing HormoneLIS Low Income SubsidyLLLT Low Level Laser Therapy

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LNT Lexical Neighborhood TestLOC Letter of ConsentLOD Letter of Denial/Revocation

Line of DutyLOI Letter of IntentLOS Length-of-StayLOT Life Orientation TestLPA Licensed Psychological AssociateLPC Licensed Professional CounselorLPN Licensed Practical NurseLSIL Low-grade Squamous Intraepithelial LesionLSN Location Storage NumberLTC Long-Term CareLUPA Low Utilization Payment AdjustmentLV Left Ventricle [Ventricular]LVEF Left Ventricular Ejection FractionLVN Licensed Vocational NurseLVRS Lung Volume Reduction SurgeryLVSD Left Ventricular Systolic DysfunctionMAC Maximum Allowable Charge

Maximum Allowable CostMAC III Mission Assurance Category IIIMAID Maximum Allowable Inpatient DayMAP MYH-Associated PolyposisMB&RS Medical Benefits and Reimbursement SectionMBI Molecular Breast ImagingMCIO Military Criminal Investigation OrganizationMCS Managed Care SupportMCSC Managed Care Support ContractorMCSS Managed Care Support ServicesMCTDP Myelomeningocele Clinical Trial Demonstration ProtocolMD Doctor of MedicineMDI Mental Developmental Index

Multiple Daily InjectionMDR MHS Data RepositoryMDS Minimum Data SetMEB Medical Evaluation BoardMEC Marketing and Education CommitteeMEI Medicare Economic IndexMEPS Military Entrance Processing StationMEPRS Medical Expense Performance Reporting SystemMESA Microsurgical Epididymal Sperm AspirationMET Microcurrent Electrical Therapy

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MFCC Marriage and Family Counseling CenterMGCRB Medicare Geographic Classification Review BoardMGIB Montgomery GI BillMH Mental HealthMHCC Maryland Health Care CommissionMHO Medical HoldoverMHS Military Health SystemMHSO Managing Health Services OrganizationMHSS Military Health Services SystemMI Myocardial InfarctionMI&L Manpower, Installations, and LogisticsMIA Missing In ActionMIAP Multi-Host Internet Access PortalMIDCAB Minimally Invasive Direct Coronary Artery Bypassmild® Minimally Invasive Lumbar DecompressionMIRE Monochromatic Infrared EnergyMLNT Multisyllabic Lexical Neighborhood TestMM Medical ManagementMMA Medicare Modernization ActMMEA Medicare and Medicaid Extenders Act (of 2010)MMP Medical Management ProgramMMPCMHP Maryland Multi-Payer Patient-Centered Medical Home ProgramMMPP Maryland Multi-Payer PatientMMR Mismatch RepairMMWR Morbidity and Mortality Weekly ReportMNR Medical Necessity ReportMOA Memorandum of AgreementMOH Medal Of HonorMOMS Management of Myelomeningocele StudyMOP Mail Order PharmacyMOU Memorandum of UnderstandingMPC Medical Payments CoverageMPI Master Patient IndexMR Magnetic Resonance

Medical ReviewMentally Retarded

MRA Magnetic Resonance AngiographyMRHFP Medicare Rural Hospital Flexibility ProgramMRI Magnetic Resonance ImagingMRPU Medical Retention Processing UnitMRS Magnetic Resonance SpectroscopyMS Microsoft®

Multiple Sclerosis

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MSA Metropolitan Statistical AreaMSC Military Sealift CommandMSI Microsatellite InstabilityMSIE Microsoft® Internet ExplorerMSP Medicare Secondary PayerMSS Medical Social ServicesMST Mountain Standard TimeMSUD Maple Syrup Urine DiseaseMSW Masters of Social Work

Medical Social WorkerMT Mountain TimeMTF Military Treatment FacilityMUE Medically Unlikely EditsMV Multivisceral (transplant)MVS Multiple Virtual StorageMWR Morale, Welfare, and RecreationMYH mutY homologN/A Not ApplicableN/D No DefaultNAC National Agency CheckNACHA National Automated Clearing House AssociationNACI National Agency Check Plus Written InquiriesNACLC National Agency Check with Law Enforcement and CreditNADFM Non-Active Duty Family MemberNARA National Archives and Records AdministrationNAS Naval Air Station

Non-Availability StatementNATO North Atlantic Treaty OrganizationNAVMED Naval Medical (Form)NBCC National Board of Certified CounselorsNCCI National Correct Coding InitiativesNCCN National Comprehensive Cancer NetworkNCD National Coverage DeterminationNCE National Counselor ExaminationNCF National Conversion FactorNCI National Cancer InstituteNCMHCE National Clinical Mental Health Counselor ExaminationNCPAP Nasal Continuous Positive Airway PressureNCPDP National Council of Prescription Drug ProgramNCQA National Committee for Quality AssuranceNCVHS National Committee on Vital and Health StatisticsNDAA National Defense Authorization Act

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NDC National Drug CodeNDMS National Disaster Medical SystemNED National Enrollment DatabaseNETT National Emphysema Treatment TrialNF Nursing FacilityNG National GuardNGPL No Government Pay ListNHLBI National Heart, Lung and Blood InstituteNHSC National Health Service CorpsNICHD National Institute of Child Health and Human DevelopmentNIH National Institutes of HealthNII Networks and Information IntegrationNIPRNET Nonsecure Internet Protocol Router NetworkNIS Naval Investigative ServiceNISPOM National Industrial Security Program Operating ManualNIST National Institute of Standards and TechnologyNLDA Nursery and Labor/Delivery AdjustmentNLT No Later ThanNMA Non-Medical AttendantNMES Neuromuscular Electrical StimulationNMOP National Mail Order PharmacyNMR Nuclear Magnetic ResonanceNMT Nurse Massage TherapistNOAA National Oceanic and Atmospheric AdministrationNoPP Notice of Private PracticesNOSCASTC National Operating Standard Cost as a Share of Total CostsNP Nurse PractitionerNPDB National Practitioner Data BankNPI National Provider IdentifierNPPES National Plan and Provider Enumeration SystemNPR Notice of Program Reimbursement NPS Naval Postgraduate SchoolNPWT Negative Pressure Wound TherapyNQF National Quality ForumNRC Nuclear Regulatory CommissionNRS Non-Routine [Medical] SupplyNSDSMEP National Standards for Diabetes Self-Management Education ProgramsNSF Non-Sufficient FundsNTIS National Technical Information ServiceNUBC National Uniform Billing CommitteeNUCC National Uniform Claims CommitteeO/ATIC Operations/Advanced Technology Integration Center

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OA Office of AdministrationOAE Otoacoustic EmissionsOASD(HA) Office of the Assistant Secretary of Defense (Health Affairs)OASD (H&E) Office of the Assistant Secretary of Defense (Health and Environment)OASD (MI&L) Office of the Assistant Secretary of Defense (Manpower, Installations, and

Logistics)OASIS Outcome and Assessment Information SetOB/GYN Obstetrician/GynecologistOBRA Omnibus Budget Reconciliation ActOCE Outpatient Code EditorOCHAMPUS Office of Civilian Health and Medical Program of the Uniformed ServicesOCMO Office of the Chief Medical OfficerOCONUS Outside of the Continental United StatesOCR Office for Civil Rights

Optical Character RecognitionOCSP Organizational Corporate Services ProviderOCT Optical Coherence TomographOD Optical DiskOF Optional FormOGC Office of General CounselOGC-AC Office of General Counsel-Appeals, Hearings & Claims Collection DivisionOGP Other Government ProgramOHI Other Health InsuranceOHS Office of Homeland SecurityOIG Office of Inspector GeneralOIT Oral ImmunotherapyOLT Orthotopic Liver TransplantationOMB Office of Management and BudgetOP/NSP Operation/Non-Surgical ProcedureOPD Outpatient DepartmentOPM Office of Personnel ManagementOPPS Outpatient Prospective Payment SystemOR Operating RoomOSA Obstructive Sleep ApneaOSAS Obstructive Sleep Apnea SyndromeOSD Office of the Secretary of DefenseOSHA Occupational Safety and Health ActOSS Office of Strategic ServicesOT Occupational Therapy (Therapist)OTC Over-The-CounterOTCD Ornithine Transcarbamylase DeficiencyOUSD Office of the Undersecretary of Defense

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OUSD (P&R) Office of the Undersecretary of Defense (Personnel and Readiness)P/O Prosthetic and OrthoticsP&CL Privacy & Civil Liberties [Office]P&T Pharmacy And Therapeutics (Committee)PA Physician AssistantPACAB Port Access Coronary Artery BypassPACO2 Partial Pressure of Carbon DioxidePAO2 Partial Pressure of OxygenPAK Pancreas After Kidney (transplant)PAP PapanicolaouPAS Privacy Act StatementPAT Performance Assessment TrackingPATH Intl Professional Association of Therapeutic Horsemanship InternationalPatID Patient IdentifierPAVM Pulmonary Arteriovenous MalformationPBM Pharmacy Benefit ManagerPBT Proton Beam TherapyPC Peritoneal Carcinomatosis

Personal ComputerProfessional Component

PCA Patient Controlled AnalgesiaPCDIS Purchased Care Detail Information SystemPCI Percutaneous Coronary InterventionPCM Primary Care ManagerPCMBN PCM By NamePCMH Patient-Centered Medical HomePCMRA PCM Research ApplicationPCMRS PCM Panel Reassignment (Application)

PCM Reassignment SystemPCO Procurement (Procuring) Contracting OfficerPCP Primary Care Physician

Primary Care ProviderPCS Pelvic Congestion Syndrome

Permanent Change of StationPCSIB Purchased Care Systems Integration BranchPD Passport DivisionPDA Patent Ductus Arteriosus

Personal Digital AssistantPDD Percutaneous (or Plasma) Disc DecompressionPDDBI Pervasive Developmental Disorders Behavior InventoryPDDNOS Pervasive Developmental Disorder Not Otherwise SpecifiedPDF Portable Document FormatPDI Potentially Disqualifying Information

C-173, October 19, 2016

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Acronyms And Abbreviations

25

PDQ Physicians’s Data QueryPDR Person Data RepositoryPDS Person Demographics ServicePDTS Pharmacy Data Transaction SystemPDX Principal DiagnosisPE Physical ExaminationPEC Pharmacoeconomic CenterPEP Partial Episode PaymentPEPR Patient Encounter Processing and ReportingPERMS Provider Education and Relations Management SystemPESA Percutaneous Epididymal Sperm AspirationPET Positron Emission TomographyPFCRA Program Fraud Civil Remedies ActPFP Partnership For PeacePFPWD Program for Persons with DisabilitiesPGD Preimplantation Genetic DiagnosisPhen-Fen Pondimin and ReduxPHI Protected Health InformationPHIMT Protected Health Information Management ToolPHP Partial Hospitalization ProgramPHS Public Health ServicePI Program Integrity (Office)PIA Privacy Impact Assessment (Online)PIC Personnel Investigation CenterPIE Pulsed Irrigation EvacuationPII Personally Identifiable InformationPIN Personnel Identification NumberPIP Personal Injury Protection

Personnel Identity ProtectionPIRFT Percutaneous Intradiscal Radiofrequency Thermocoagulation (PIRFT)PIT PCM Information TransferPIV Personal Identity VerificationPK Public KeyPKE Public Key EnablingPKI Public Key InfrastructurePKU PhenylketonuriaPLS Preschool Language ScalesPM-DRG Pediatric Modified-Diagnosis Related GroupPMPM Per Member Per MonthPMR Percutaneous Myocardial Laser RevascularizationPMRC Patient Movement Requirement CenterPNET Primitive Neuroectodermal Tumors

C-173, October 19, 2016

TRICARE Policy Manual 6010.57-M, February 1, 2008 Appendix A

Acronyms And Abbreviations

26

PNT Policy Notification TransactionPOA Power of Attorney

Present On AdmissionPOA&M Plan of Action and MilestonesPOC Pharmacy Operations Center

Plan of CarePoint of Contact

POL May 1996 TRICARE/CHAMPUS Policy Manual 6010.47-MPOS Point of Sale (Pharmacy only)

Point of ServicePublic Official’s Statement

POV Privately Owned VehiclePPACA Patient Protection and Affordable Care ActPPC-PCMH Physician Practice Connections Patient-Centered Medical HomePPD Per Patient DayPPN Preferred Provider NetworkPPO Preferred Provider OrganizationPPP Purchasing Power ParityPPS Prospective Payment System

Ports, Protocols and ServicesPPSM Ports, Protocols, and Service ManagementPPV Pneumococcal Polysaccharide VaccinePQI Potential Quality Indicator

Potential Quality IssuePR Periodic ReinvestigationPRC Program Review CommitteePRFA Percutaneous Radiofrequency AblationPRG Peer Review GroupPRO Peer Review OrganizationProDUR Prospective Drug Utilization ReviewPROM Programmable Read-Only MemoryPRP Personnel Reliability ProgramPRPP Pharmacy Redesign Pilot ProjectPSA Prime Service Area

Physician Scarcity AreaPSAB Personnel Security Appeals BoardPSCT Peripheral Stem Cell TransplantationPSD Personnel Security DivisionPSF Provider Specific FilePSG PolysomnographyPSI Personnel Security InvestigationPST Pacific Standard Time

C-173, October 19, 2016

TRICARE Policy Manual 6010.57-M, February 1, 2008 Appendix A

Acronyms And Abbreviations

29

SBCC Service Branch Classification CodeSBI Special Background InvestigationSCA Service Contract ActSCH Sole Community HospitalSCHF Stable Chronic Heart FailureSCHIP State Children’s Health Insurance ProgramSCI Sensitive Compartmented Information

Spinal Cord InjurySCIC Significant Change in ConditionSCOO Special Contracts and Operations OfficeSCR Stem Cell RescueS/D Security DivisionSD (Form) Secretary of Defense (Form)SEP Sensory Evoked PotentialsSES Senior Executive ServiceSelRes Selected ReserveSF Standard FormSFTP Secure File Transfer ProtocolSGDs Speech Generating DevicesSHCP Supplemental Health Care ProgramSI Sensitive Information

Small Intestine (transplant)Special Indicator (code)Status Indicator

SIDS Sudden Infant Death SyndromeSIF Source Input FormatSII Special Investigative InquirySI/L Small Intestine-Live (transplant)SIOP-ESI Single Integrated Operational plan-Extremely Sensitive InformationSIP System Identification ProfileSIRT Selective Internal Radiation TherapySIT Standard Insurance TableSLP Speech-Language PathologySMC System Management CenterSME Subject Matter ExpertSMHC Supervised Mental Health CounselorSN Skilled NursingSNF Skilled Nursing FacilitySNS Sacral Nerve Root StimulationSOC Start of CareSOFA Status Of Forces AgreementSOIC Senior Officer of the Intelligence CommunitySON Submitting Office Number

C-173, October 19, 2016

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Acronyms And Abbreviations

30

SOR Statement of ReasonsStatement of ResponsibilitiesSystem of Records

SORN System of Records NoticeSP Special PublicationSPA Simple Power AnalysisSPC Special Processing CodeSPECT Single Photon Emission Computed TomographySPK Simultaneous Pancreas Kidney (transplant) SPR SECRET Periodic ReinvestigationSQL Structured Query LanguageSRE Serious Reportable EventSSA Social Security Act

Social Security AdministrationSSAA Social Security Authorization AgreementSSAN Social Security Administration NumberSSBI Single-Scope Background InvestigationSSDI Social Security Disability InsuranceSSL Secure Socket LayerSSM Site Security ManagerSSN Social Security NumberSSO Short-Stay OutlierST Speech TherapySTF Specialized Treatment FacilitySTS Specialized Treatment ServicesSTSF Specialized Treatment Service FacilitySUBID Sub-IdentifierSUD Substance Use DisorderSUDRF Substance Use Disorder Rehabilitation FacilitySVO SIT Validation OfficeSVP State Vaccine Program

State Vaccine Program entitySVT Supraventricular TachycardiaSWLS Satisfaction With Life ScaleT-3 TRICARE Third GenerationTAD Temporary Additional DutyTAFIM Technical Architecture Framework for Information ManagementTAH Total Artificial HeartTAMP Transitional Assistance Management ProgramTAO TRICARE Alaska Office

TRICARE Area OfficeTAR Total Ankle ReplacementTARO TRICARE Alaska Regional Office

C-164, June 17, 2016