TRICARE to Pay Ambulances for Mid-Ride Blood Transfusions
Published Date: 7/6/2026
Notice
Summary
Starting January 1, 2027, TRICARE will test a new way to pay ambulance providers separately for giving blood transfusions before patients reach the hospital. This 5-year project aims to save lives, improve care, and see if this payment change makes sense long-term for trauma patients using TRICARE. It could affect costs and access to care for military families and veterans who need emergency blood transfusions during ambulance rides.
Analyzed Economic Effects
5 provisions identified: 1 benefits, 2 costs, 2 mixed.
TRICARE tests ambulance blood-pay add-on
Starting January 1, 2027, TRICARE will run a five-year demonstration (ending December 31, 2031) that pays ambulance providers a separate add-on for medically necessary pre-hospital blood transfusions during ambulance, air, or ground transport. The project will test whether this payment change improves outcomes, affects total cost of care, and improves access for trauma patients.
Beneficiaries may face higher out-of-pocket
Under the demonstration, beneficiaries remain subject to their plan's cost-sharing, deductibles, and copayments. Because many ambulance providers are out of network and TRICARE uses percentage-based cost sharing for out-of-network care, beneficiaries may experience increases in out-of-pocket costs when an add-on is paid.
TRICARE for Life beneficiaries pay 25% co-pay
During the demonstration, TRICARE For Life (TFL) beneficiaries will have an additional add-on co-pay equal to 25 percent of the TRICARE allowed ambulance add-on reimbursement for authorized pre-hospital blood transfusions.
Two-tier payment for ambulance blood costs
Ambulance providers eligible for the demonstration can receive a two-tier add-on: (1) the hospital OPPS rate per unit using HCPCS code P9010 (currently $189.84), or (2) the actual cost of the blood product if an invoice from the blood bank is submitted. Providers may also bill CPT 36430 for transfusion administration, reimbursed at the CHAMPUS Maximum Allowable Charge (about $40).
Who is included and who is excluded
Eligible beneficiaries for the demonstration include those covered under TRICARE Prime (including Active-Duty Service Members), TRICARE Select, and TRICARE For Life (including those in Medicare Advantage). Excluded are beneficiaries in the Uniformed Services Family Health Plan, the Competitive Plans Demonstration (or future iterations), claims outside the 50 United States and territories, and beneficiaries for whom TRICARE is not the primary payer.
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