Skip to Content

Notice

Reasonable Charges for Medical Care or Services; 2004 Calendar Year Update

Document Details

Information about this document as published in the Federal Register.

Published Document

This document has been published in the Federal Register. Use the PDF linked in the document sidebar for the official electronic format.

Start Preamble Start Printed Page 20118

AGENCY:

Department of Veterans Affairs.

ACTION:

Notice.

SUMMARY:

Section 17.101 of Title 38 of the Code of Federal Regulations 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 a nonservice-connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health plan contract;

—For a nonservice-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

—For a nonservice-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/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 in 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.” Some of these charges are hereby updated as described in the SUPPLEMENTARY INFORMATION section of this notice. These changes are effective April 15, 2004.

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 of the regulations, the method for determining VA's charges is set forth at 38 CFR 17.101(a)(8).

This notice also includes a correction to Table G, Physician and Other Professional Services Relative Value Units (RVUS) by CPT/HCPCS Code.

Start Further Info

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) 254-0361. (This is not a toll free number.)

End Further Info End Preamble Start Supplemental Information

SUPPLEMENTARY INFORMATION:

Of the charge types listed in the Summary section of this notice, acute inpatient facility charges and skilled nursing facility/sub-acute inpatient facility charges are not being changed. Acute inpatient facility charges remain the same as set forth in a notice published in the Federal Register on December 19, 2003 (68 FR 70867). Skilled nursing facility/sub-acute inpatient facility charges remain the same as set forth in a notice published in the Federal Register on October 2, 2003 (68 FR 56892).

Based on the methodologies set forth in 38 CFR 17.101, this document provides an update to charges for 2004 HCPCS Level II and Current Procedural Technology (CPT) codes. Charges are also being updated based on more recent versions of data sources for the following charge types: 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 HCPCS Level II codes. These updated charges are effective April 15, 2004.

In this update, we are retaining the table designations used in the notice published in the Federal Register on October 2, 2003 (68 FR 56892). Accordingly, the tables identified as being updated by this notice correspond to the applicable tables published in the October 2 notice, beginning with Table C. Table G is not being updated but is being republished in this notice to reflect a correction to the data in columns titled Facility Practice Expense RVU's and Non-Facility Practice Expense RVU's which were inadvertently reversed in the October 2, 2003 Federal Register Notice.

We have updated the list of data sources presented in Supplementary Table 1 to reflect the updated data sources used to establish the updated charges described in this notice.

As a reminder, in Supplementary Table 3 published in the Federal Register dated December 19, 2003, we set forth the list of VA medical facility locations, which includes their three-digit Zip Codes and provider-based/non-provider-based designations. In accordance with the final rule, subsequent updates to Supplementary Table 3 will be posted on the Internet site of the Veterans Health Administration Chief Business Office.

Consistent with the regulations, the updated data tables and supplementary tables containing the changes described are published with this notice and will be effective until changed by a subsequent Federal Register notice.

Start Signature
Approved: March 22, 2004.

Anthony J. Principi,

Secretary of Veterans Affairs.

End Signature Start Printed Page 20119

Start Printed Page 20120

Start Printed Page 20121

Start Printed Page 20122

Start Printed Page 20123

Start Printed Page 20124

Start Printed Page 20125

Start Printed Page 20126

Start Printed Page 20127

Start Printed Page 20128

Start Printed Page 20129

Start Printed Page 20130

Start Printed Page 20131

Start Printed Page 20132

Start Printed Page 20133

Start Printed Page 20134

Start Printed Page 20135

Start Printed Page 20136

Start Printed Page 20137

Start Printed Page 20138

Start Printed Page 20139

Start Printed Page 20140

Start Printed Page 20141

Start Printed Page 20142

Start Printed Page 20143

Start Printed Page 20144

Start Printed Page 20145

Start Printed Page 20146

Start Printed Page 20147

Start Printed Page 20148

Start Printed Page 20149

Start Printed Page 20150

Start Printed Page 20151

Start Printed Page 20152

Start Printed Page 20153

Start Printed Page 20154

Start Printed Page 20155

Start Printed Page 20156

Start Printed Page 20157

Start Printed Page 20158

Start Printed Page 20159

Start Printed Page 20160

Start Printed Page 20161

Start Printed Page 20162

Start Printed Page 20163

Start Printed Page 20164

Start Printed Page 20165

Start Printed Page 20166

Start Printed Page 20167

Start Printed Page 20168

Start Printed Page 20169

Start Printed Page 20170

Start Printed Page 20171

Start Printed Page 20172

Start Printed Page 20173

Start Printed Page 20174

Start Printed Page 20175

Start Printed Page 20176

Start Printed Page 20177

Start Printed Page 20178

Start Printed Page 20179

Start Printed Page 20180

Start Printed Page 20181

Start Printed Page 20182

Start Printed Page 20183

Start Printed Page 20184

Start Printed Page 20185

Start Printed Page 20186

Start Printed Page 20187

Start Printed Page 20188

Start Printed Page 20189

Start Printed Page 20190

Start Printed Page 20191

Start Printed Page 20192

Start Printed Page 20193

Start Printed Page 20194

Start Printed Page 20195

Start Printed Page 20196

Start Printed Page 20197

Start Printed Page 20198

Start Printed Page 20199

Start Printed Page 20200

Start Printed Page 20201

Start Printed Page 20202

Start Printed Page 20203

Start Printed Page 20204

Start Printed Page 20205

Start Printed Page 20206

Start Printed Page 20207

Start Printed Page 20208

Start Printed Page 20209

Start Printed Page 20210

Start Printed Page 20211

Start Printed Page 20212

Start Printed Page 20213

Start Printed Page 20214

Start Printed Page 20215

Start Printed Page 20216

Start Printed Page 20217

Start Printed Page 20218

Start Printed Page 20219

Start Printed Page 20220

Start Printed Page 20221

Start Printed Page 20222

Start Printed Page 20223

Start Printed Page 20224

Start Printed Page 20225

Start Printed Page 20226

Start Printed Page 20227

Start Printed Page 20228

Start Printed Page 20229

Start Printed Page 20230

Start Printed Page 20231

Start Printed Page 20232

Start Printed Page 20233

Start Printed Page 20234

Start Printed Page 20235

Start Printed Page 20236

Start Printed Page 20237

Start Printed Page 20238

Start Printed Page 20239

Start Printed Page 20240

Start Printed Page 20241

Start Printed Page 20242

Start Printed Page 20243

Start Printed Page 20244

Start Printed Page 20245

Start Printed Page 20246

Start Printed Page 20247

Start Printed Page 20248

Start Printed Page 20249

Start Printed Page 20250

Start Printed Page 20251

Start Printed Page 20252

Start Printed Page 20253

Start Printed Page 20254

Start Printed Page 20255

Start Printed Page 20256

Start Printed Page 20257

Start Printed Page 20258

Start Printed Page 20259

Start Printed Page 20260

Start Printed Page 20261

Start Printed Page 20262

Start Printed Page 20263

Start Printed Page 20264

Start Printed Page 20265

Start Printed Page 20266

Start Printed Page 20267

Start Printed Page 20268

Start Printed Page 20269

Start Printed Page 20270

Start Printed Page 20271

Start Printed Page 20272

Start Printed Page 20273

Start Printed Page 20274

Start Printed Page 20275

Start Printed Page 20276

Start Printed Page 20277

Start Printed Page 20278

Start Printed Page 20279

Start Printed Page 20280

Start Printed Page 20281

Start Printed Page 20282

Start Printed Page 20283

Start Printed Page 20284

Start Printed Page 20285

Start Printed Page 20286

Start Printed Page 20287

Start Printed Page 20288

Start Printed Page 20289

Start Printed Page 20290

Start Printed Page 20291

Start Printed Page 20292

Start Printed Page 20293

Start Printed Page 20294

Start Printed Page 20295

Start Printed Page 20296

Start Printed Page 20297

Start Printed Page 20298

Start Printed Page 20299

Start Printed Page 20300

Start Printed Page 20301

Start Printed Page 20302

Start Printed Page 20303

Start Printed Page 20304

Start Printed Page 20305

Start Printed Page 20306

Start Printed Page 20307

Start Printed Page 20308

Start Printed Page 20309

Start Printed Page 20310

Start Printed Page 20311

Start Printed Page 20312

Start Printed Page 20313

Start Printed Page 20314

Start Printed Page 20315

Start Printed Page 20316

Start Printed Page 20317

Start Printed Page 20318

Start Printed Page 20319

Start Printed Page 20320

Start Printed Page 20321

Start Printed Page 20322

Start Printed Page 20323

Start Printed Page 20324

Start Printed Page 20325

Start Printed Page 20326

Start Printed Page 20327

Start Printed Page 20328

Start Printed Page 20329

Start Printed Page 20330

Start Printed Page 20331

Start Printed Page 20332

Start Printed Page 20333

Start Printed Page 20334

Start Printed Page 20335

Start Printed Page 20336

Start Printed Page 20337

Start Printed Page 20338

Start Printed Page 20339

Start Printed Page 20340

Start Printed Page 20341

Start Printed Page 20342

Start Printed Page 20343

Start Printed Page 20344

Start Printed Page 20345

Start Printed Page 20346

Start Printed Page 20347

Start Printed Page 20348

Start Printed Page 20349

Start Printed Page 20350

Start Printed Page 20351

Start Printed Page 20352

Start Printed Page 20353

Start Printed Page 20354

Start Printed Page 20355

Start Printed Page 20356

Start Printed Page 20357

Start Printed Page 20358

Start Printed Page 20359

Start Printed Page 20360

Start Printed Page 20361

Start Printed Page 20362

Start Printed Page 20363

Start Printed Page 20364

Start Printed Page 20365

Start Printed Page 20366

Start Printed Page 20367

Start Printed Page 20368

Start Printed Page 20369

Start Printed Page 20370

Start Printed Page 20371

Start Printed Page 20372

Start Printed Page 20373

Start Printed Page 20374

Start Printed Page 20375

Start Printed Page 20376

Start Printed Page 20377

Start Printed Page 20378

Start Printed Page 20379

Start Printed Page 20380

Start Printed Page 20381

Start Printed Page 20382

Start Printed Page 20383

Start Printed Page 20384

Start Printed Page 20385

Start Printed Page 20386

Start Printed Page 20387

Start Printed Page 20388

Start Printed Page 20389

Start Printed Page 20390

Start Printed Page 20391

Start Printed Page 20392

Start Printed Page 20393

Start Printed Page 20394

Start Printed Page 20395

Start Printed Page 20396

Start Printed Page 20397

Start Printed Page 20398

Start Printed Page 20399

Start Printed Page 20400

Start Printed Page 20401

Start Printed Page 20402

Start Printed Page 20403

Start Printed Page 20404

Start Printed Page 20405

Start Printed Page 20406

Start Printed Page 20407

Start Printed Page 20408

Start Printed Page 20409

Start Printed Page 20410

Start Printed Page 20411

Start Printed Page 20412

Start Printed Page 20413

Start Printed Page 20414

Start Printed Page 20415

Start Printed Page 20416

Start Printed Page 20417

Start Printed Page 20418

Start Printed Page 20419

Start Printed Page 20420

Start Printed Page 20421

Start Printed Page 20422

Start Printed Page 20423

Start Printed Page 20424

Start Printed Page 20425

Start Printed Page 20426

Start Printed Page 20427

Start Printed Page 20428

Start Printed Page 20429

Start Printed Page 20430

Start Printed Page 20431

Start Printed Page 20432

Start Printed Page 20433

Start Printed Page 20434

Start Printed Page 20435

Start Printed Page 20436

Start Printed Page 20437

Start Printed Page 20438

Start Printed Page 20439

Start Printed Page 20440

Start Printed Page 20441

Start Printed Page 20442

Start Printed Page 20443

Start Printed Page 20444

Start Printed Page 20445

Start Printed Page 20446

Start Printed Page 20447

Start Printed Page 20448

Start Printed Page 20449

Start Printed Page 20450

Start Printed Page 20451

Start Printed Page 20452

Start Printed Page 20453

Start Printed Page 20454

Start Printed Page 20455

Start Printed Page 20456

Start Printed Page 20457

Start Printed Page 20458

Start Printed Page 20459

Start Printed Page 20460

Start Printed Page 20461

Start Printed Page 20462

Start Printed Page 20463

Start Printed Page 20464

Start Printed Page 20465

Start Printed Page 20466

Start Printed Page 20467

Start Printed Page 20468

Start Printed Page 20469

Start Printed Page 20470

Start Printed Page 20471

Start Printed Page 20472

Start Printed Page 20473

Start Printed Page 20474

Start Printed Page 20475

Start Printed Page 20476

Start Printed Page 20477

Start Printed Page 20478

Start Printed Page 20479

Start Printed Page 20480

Start Printed Page 20481

Start Printed Page 20482

Start Printed Page 20483

Start Printed Page 20484

Start Printed Page 20485

Start Printed Page 20486

Start Printed Page 20487

Start Printed Page 20488

Start Printed Page 20489

Start Printed Page 20490

Start Printed Page 20491

Start Printed Page 20492

Start Printed Page 20493

Start Printed Page 20494

Start Printed Page 20495

Start Printed Page 20496

Start Printed Page 20497

Start Printed Page 20498

Start Printed Page 20499

Start Printed Page 20500

Start Printed Page 20501

Start Printed Page 20502

Start Printed Page 20503

Start Printed Page 20504

Start Printed Page 20505

Start Printed Page 20506

Start Printed Page 20507

Start Printed Page 20508

Start Printed Page 20509

Start Printed Page 20510

Start Printed Page 20511

Start Printed Page 20512

Start Printed Page 20513

Start Printed Page 20514

Start Printed Page 20515

Start Printed Page 20516

Start Printed Page 20517

Start Printed Page 20518

Start Printed Page 20519

Start Printed Page 20520

Start Printed Page 20521

End Supplemental Information

BILLING CODE 8320-01-P

[FR Doc. 04-7913 Filed 4-14-04; 8:45 am]

BILLING CODE 8320-01-C