VA: Reasonable Charges for Medical Care or Services; 2009 Calendar Year Update

Title 38 of the Code of Federal Regulations (CFR), Sec. 17.101 sets forth the Department of Veterans Affairs (VA) medical regulations concerning ``reasonable charges'' for medical care or services provided or furnished by VA to a veteran for: (1) A non-service-connected disability for which the veteran is entitled to care or the payment of expenses for care under a health plan contract; (2) a non-service-connected disability incurred incident to the veteran's employment and covered under a worker's compensation law or plan that provides reimbursement or indemnification for such care and services; or (3) a non-service-connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. The regulations include methodologies for establishing billed amounts for the following types of charges:

• Acute inpatient facility charges;
• skilled nursing facility and sub-acute inpatient facility charges;
• partial hospitalization facility charges;
• outpatient facility charges;
• physician and other professional charges, including professional charges for anesthesia services and dental services;
• pathology and laboratory charges;
• observation care facility charges;
• ambulance and other emergency transportation charges; and
• charges for durable medical equipment, drugs, injectables, and other medical services, items, and supplies identified by Healthcare Common Procedure Coding System (HCPCS) Level II codes.

The regulations also provide that data for calculating actual charge amounts at individual VA facilities based on these methodologies will either be published as a notice in the Federal Register or will be posted on the Internet site of the Veterans Health Administration Chief Business Office, currently at http://www.va.gov/cbo, under ``Charge Data.''

The charge tables and supplemental tables that are applicable to this Federal Register notice can be viewed on the Veterans Health Administration Chief Business Office's Intranet and Internet Web sites. Certain charges are hereby updated as described in the SUPPLEMENTARY INFORMATION Section of this notice. These changes are effective January 1, 2009.

In circumstances when charges for medical care or services provided or furnished at VA expense, by either VA or non-VA providers, have not been established under other provisions or regulations, the method for determining VA's charges is set forth at 38 CFR 17.101(a)(8).FOR FURTHER INFORMATION CONTACT: Romona Greene, Chief Business Office (168), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 461-1595. (This is not a toll-free number.)