Low-value care (LVC), defined as overuse or care which does not benefit the patient, is a major contributor to unnecessary costs and systemic waste in healthcare. A 2019 study in the Military Health System (MHS) demonstrated differing patterns of LVC between care provided at military facilities (direct care, DC) vs. civilian facilities (private sector care, PC). The MHS has since reorganized to prioritize DC for active-duty service members and refer others to PC, while at the same time the LVC assessment tool was updated based on current guidelines. This study assessed LVC in the MHS adult population following these changes, beginning with 8 measures which were used in both the old and new tools. Using 2024 TRICARE claims data and ICD-10 codes, we extracted data for the 11 measures, which included 5 imaging procedures, 2 monitoring procedures, and 2 interventions. Eight measures were calculated per 1000 eligible episodes, and 3 measures were calculated per 1000 eligible beneficiaries. We compared the rates of LVC use between the direct care (DC) and purchased care systems (PC) using risk ratio (RR) with 95% confidence intervals. Rate of overuse per 1,000 episodes ranged from 2.5 in DC/ 1.4 in PC for sinus CT for acute uncomplicated rhinosinusitis (RR 0.48; P<0.001), to 758.9 DC/ 893.2 PC for MRI of the lumbar spine for low back pain (RR=0.78; P=0.032). Rate of overuse per 1000 eligible beneficiaries ranged from 0.13 DC/1.8 PC for Spinal fusion among those who had MRI of the lumbar spine for low back pain (RR=0.07; P=0.036), to 162.7 DC/255.6 for traction for low back pain (RR=0.76; P<0.001). DC showed greater LVC in three measures, and PSC in four measures, with one measure not showing a statistically significant difference between the two care arenas. The greatest difference in LVC between the two care arenas was in Sinus CT or antibiotics for uncomplicated acute rhinosinusitis, however, the overall usage was low at 2.5/1000 eligible beneficiaries in DC and 1.4/1000 in PSC. The greatest usage of LVC overall was in traction for MRI of the lumbar spine for low back pain. In comparison with our prior data, rates of LVC increased overall in 4 measures in DC and 3 measures in PSC, decreased overall in 4 measures in DC and 3 measures in PSC. The changes were minor overall and patterns of LVC between the two care arenas largely mirrored the results from the previous study. This study demonstrates the persistence of LVC across care arenas since the 2019 study of LVC in the MHS, with the greatest improvement opportunity likely in the use of traction for low back pain. Further studies will include 8-9 additional LVC measures, and assessment across race, age, and rank as a proxy for socioeconomic status. Findings are expected to inform discussions about healthcare reform and cost drivers in the MHS and the Nation.