State Prevailing Rates
State prevailing rates refer to the charges applied to Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes when the Defense Health Agency (DHA) has not set specific rates. It’s important to note that CHAMPUS Maximum Allowable Charges (CMAC) override these state prevailing rates whenever applicable.
How to Use the Rate Tables
- Filter to the appropriate state from the list (an excel file will open).
- Filter to the appropriate procedure code associated with the claim.
- If there are multiple rates for one procedure code, narrow your search to the claim's specific provider class and modifier.
- Information in the rate table is based on the claim’s date of service (DOS). Verify that the claim's date of service falls between that rate's effective date and expiration date.