DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Medical Care or Services; 2005 Calendar Year Update
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 11, 2005.
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).
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.)
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 15, 2004 (69 FR 75111). Skilled nursing facility/sub-acute inpatient facility charges remain the same as set forth in a notice published in the
Federal Register
on December 15, 2004 (69 FR 75111).
Based on the methodologies set forth in 38 CFR 17.101, this document provides an update to charges for 2005 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 11, 2005.
In this update, we are retaining the table designations used in the notice published in the
Federal Register
on April 15, 2004 (69 FR 20118). Accordingly, the tables identified as being updated by this notice correspond to the applicable tables published in the notice, beginning with Table C.
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 April 15, 2004, 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. The updated data tables and supplementary tables containing the changes described will be effective until changed by a subsequent
Federal Register
notice.
Approved: February 14, 2005.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
BILLING CODE 8320–01–P
EN11AP05.000
EN11AP05.001
EN11AP05.002
EN11AP05.003
EN11AP05.004
EN11AP05.005
EN11AP05.006
EN11AP05.007
EN11AP05.008
EN11AP05.009
EN11AP05.010
EN11AP05.011
EN11AP05.012
EN11AP05.013
EN11AP05.014
EN11AP05.015
EN11AP05.016
EN11AP05.017
EN11AP05.018
EN11AP05.019
EN11AP05.020
EN11AP05.021
EN11AP05.022
EN11AP05.023
EN11AP05.024
EN11AP05.025
EN11AP05.026
EN11AP05.027
EN11AP05.028
EN11AP05.029
EN11AP05.030
EN11AP05.031
EN11AP05.032
EN11AP05.033
EN11AP05.034
EN11AP05.035
EN11AP05.036
EN11AP05.037
EN11AP05.038
EN11AP05.039
EN11AP05.040
EN11AP05.041
EN11AP05.042
EN11AP05.043
EN11AP05.044
EN11AP05.045
EN11AP05.046
EN11AP05.047
EN11AP05.048
EN11AP05.049
EN11AP05.050
EN11AP05.051
EN11AP05.052
EN11AP05.053
EN11AP05.054
EN11AP05.055
EN11AP05.056
EN11AP05.057
EN11AP05.058
EN11AP05.059
EN11AP05.060
EN11AP05.061
EN11AP05.062
EN11AP05.063
EN11AP05.064
EN11AP05.065
EN11AP05.066
EN11AP05.067
EN11AP05.068
EN11AP05.069
EN11AP05.070
EN11AP05.071
EN11AP05.072
EN11AP05.073
EN11AP05.074
EN11AP05.075
EN11AP05.076
EN11AP05.077
EN11AP05.078
EN11AP05.079
EN11AP05.080
EN11AP05.081
EN11AP05.082
EN11AP05.083
EN11AP05.084
EN11AP05.085
EN11AP05.086
EN11AP05.087
EN11AP05.088
EN11AP05.089
EN11AP05.090
EN11AP05.091
EN11AP05.092
EN11AP05.093
EN11AP05.094
EN11AP05.095
EN11AP05.096
EN11AP05.097
EN11AP05.098
EN11AP05.099
EN11AP05.100
EN11AP05.101
EN11AP05.102
EN11AP05.103
EN11AP05.104
EN11AP05.105
EN11AP05.106
EN11AP05.107
EN11AP05.108
EN11AP05.109
EN11AP05.110
EN11AP05.111
EN11AP05.112
EN11AP05.113
EN11AP05.114
EN11AP05.115
EN11AP05.116
EN11AP05.117
EN11AP05.118
EN11AP05.119
EN11AP05.120
EN11AP05.121
EN11AP05.122
EN11AP05.123
EN11AP05.124
EN11AP05.125
EN11AP05.126
EN11AP05.127
EN11AP05.128
EN11AP05.129
EN11AP05.130
EN11AP05.131
EN11AP05.132
EN11AP05.133
EN11AP05.134
EN11AP05.135
EN11AP05.136
EN11AP05.137
EN11AP05.138
EN11AP05.139
EN11AP05.140
EN11AP05.141
EN11AP05.142
EN11AP05.143
EN11AP05.144
EN11AP05.145
EN11AP05.146
EN11AP05.147
EN11AP05.148
EN11AP05.149
EN11AP05.150
EN11AP05.151
EN11AP05.152
EN11AP05.153
EN11AP05.154
EN11AP05.155
EN11AP05.156
EN11AP05.157
EN11AP05.158
EN11AP05.159
EN11AP05.160
EN11AP05.161
EN11AP05.162
EN11AP05.163
EN11AP05.164
EN11AP05.165
EN11AP05.166
EN11AP05.167
EN11AP05.168
EN11AP05.169
EN11AP05.170
EN11AP05.171
EN11AP05.172
EN11AP05.173
EN11AP05.174
EN11AP05.175
EN11AP05.176
EN11AP05.177
EN11AP05.178
EN11AP05.179
EN11AP05.180
EN11AP05.181
EN11AP05.182
EN11AP05.183
EN11AP05.184
EN11AP05.185
EN11AP05.186
EN11AP05.187
EN11AP05.188
EN11AP05.189
EN11AP05.190
EN11AP05.191
EN11AP05.192
EN11AP05.193
EN11AP05.194
EN11AP05.195
EN11AP05.196
EN11AP05.197
EN11AP05.198
EN11AP05.199
EN11AP05.200
EN11AP05.201
EN11AP05.202
EN11AP05.203
EN11AP05.204
EN11AP05.205
EN11AP05.206
EN11AP05.207
EN11AP05.208
EN11AP05.209
EN11AP05.210
EN11AP05.211
EN11AP05.212
EN11AP05.213
EN11AP05.214
EN11AP05.215
EN11AP05.216
EN11AP05.217
EN11AP05.218
EN11AP05.219
EN11AP05.220
EN11AP05.221
EN11AP05.222
EN11AP05.223
EN11AP05.224
EN11AP05.225
EN11AP05.226
EN11AP05.227
EN11AP05.228
EN11AP05.229
EN11AP05.230
EN11AP05.231
EN11AP05.232
EN11AP05.233
EN11AP05.234
EN11AP05.235
EN11AP05.236
EN11AP05.237
EN11AP05.238
EN11AP05.239
EN11AP05.240
EN11AP05.241
EN11AP05.242
EN11AP05.243
EN11AP05.244
EN11AP05.245
EN11AP05.246
EN11AP05.247
EN11AP05.248
EN11AP05.249
EN11AP05.250
EN11AP05.251
EN11AP05.252
EN11AP05.253
EN11AP05.254
EN11AP05.255
EN11AP05.256
EN11AP05.257
EN11AP05.258
EN11AP05.259
EN11AP05.260
EN11AP05.261
EN11AP05.262
EN11AP05.263
EN11AP05.264
EN11AP05.265
EN11AP05.266
EN11AP05.267
EN11AP05.268
EN11AP05.269
EN11AP05.270
EN11AP05.271
EN11AP05.272
EN11AP05.273
EN11AP05.274
EN11AP05.275
EN11AP05.276
EN11AP05.277
EN11AP05.278
EN11AP05.279
EN11AP05.280
EN11AP05.281
EN11AP05.282
EN11AP05.283
EN11AP05.284
EN11AP05.285
EN11AP05.286
EN11AP05.287
EN11AP05.288
EN11AP05.289
EN11AP05.290
EN11AP05.291
EN11AP05.292
EN11AP05.293
EN11AP05.294
EN11AP05.295
EN11AP05.296
EN11AP05.297
EN11AP05.298
EN11AP05.299
EN11AP05.300
EN11AP05.301
EN11AP05.302
EN11AP05.303
EN11AP05.304
EN11AP05.305
EN11AP05.306
EN11AP05.307
EN11AP05.308
EN11AP05.309
EN11AP05.310
EN11AP05.311
EN11AP05.312
EN11AP05.313
EN11AP05.314
EN11AP05.315
EN11AP05.316
EN11AP05.317
EN11AP05.318
EN11AP05.319
EN11AP05.320
EN11AP05.321
EN11AP05.322
EN11AP05.323
EN11AP05.324
EN11AP05.325
EN11AP05.326
EN11AP05.327
EN11AP05.328
EN11AP05.329
EN11AP05.330
EN11AP05.331
EN11AP05.332
EN11AP05.333
EN11AP05.334
EN11AP05.335
EN11AP05.336
EN11AP05.337
EN11AP05.338
EN11AP05.339
EN11AP05.340
EN11AP05.341
EN11AP05.342
EN11AP05.343
EN11AP05.344
EN11AP05.345
EN11AP05.346
EN11AP05.347
EN11AP05.348
EN11AP05.349
EN11AP05.350
EN11AP05.351
EN11AP05.352
EN11AP05.353
EN11AP05.354
EN11AP05.355
EN11AP05.356
EN11AP05.357
EN11AP05.358
EN11AP05.359
EN11AP05.360
EN11AP05.361
EN11AP05.362
EN11AP05.363
EN11AP05.364
EN11AP05.365
EN11AP05.366
EN11AP05.367
EN11AP05.368
EN11AP05.369
EN11AP05.370
EN11AP05.371
EN11AP05.372
EN11AP05.373
EN11AP05.374
EN11AP05.375
EN11AP05.376
EN11AP05.377
EN11AP05.378
EN11AP05.379
EN11AP05.380
EN11AP05.381
EN11AP05.382
EN11AP05.383
EN11AP05.384
EN11AP05.385
EN11AP05.386
EN11AP05.387
EN11AP05.388
EN11AP05.389
EN11AP05.390
EN11AP05.391
EN11AP05.392
EN11AP05.393
EN11AP05.394
EN11AP05.395
EN11AP05.396
EN11AP05.397
EN11AP05.398
EN11AP05.399
EN11AP05.400
EN11AP05.401
EN11AP05.402
EN11AP05.403
EN11AP05.404
EN11AP05.405
EN11AP05.406
EN11AP05.407
EN11AP05.408
EN11AP05.409
EN11AP05.410
EN11AP05.411
EN11AP05.412
EN11AP05.413
EN11AP05.414
EN11AP05.415
EN11AP05.416
EN11AP05.417
EN11AP05.418
EN11AP05.419
EN11AP05.420
EN11AP05.421
EN11AP05.422
EN11AP05.423
EN11AP05.424
EN11AP05.425
EN11AP05.426
EN11AP05.427
EN11AP05.428
EN11AP05.429
EN11AP05.430
EN11AP05.431
EN11AP05.432
EN11AP05.433
EN11AP05.434
EN11AP05.435
EN11AP05.436
EN11AP05.437
EN11AP05.438
EN11AP05.439
EN11AP05.440
EN11AP05.441
EN11AP05.442
EN11AP05.443
EN11AP05.444
EN11AP05.445
EN11AP05.446
EN11AP05.447
EN11AP05.448
EN11AP05.449
EN11AP05.450
EN11AP05.451