Clinical Determinations and Indications Library
Below is a list of published Clinical Determinations and Indications (CDI) community providers may use as a resource to help determine if a Veteran meets VA clinical criteria for services and procedures delivered in the community.
NOTE: While these CDIs are intended for community providers, VA providers and staff should use them as a reference when determining clinical appropriateness for Veterans to receive a specific service in the community.
Search Instructions
If you are unable to find the CDI you are looking for, please use the VA search function to search for keywords related to the appropriate medical policy.
Library of Clinical Determinations and Indications
Use of this content indicates your agreement and acceptance to the terms and conditions listed in the Agreement to Access Library of Clinical Determinations and Indications.
View Agreement to Access Library of Clinical Determinations and Indications
- Autologous Chondrocyte Implantation
- Bioimpedance Devices for Detection of Lymphedema
- Cataract Extraction and Intraocular Lens Implant
- Cryoablation for Malignant Breast Tumors
- Extracorporeal Shock Wave Therapy for Musculoskeletal Conditions
- Fecal Microbiota Products for Clostridioides difficile Infections
- Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
- Intranasal Esketamine for Treatment Resistant Depression
- Ketamine for Chronic Pain
- Magnetic Resonance-Guided Focused Ultrasound (MRgFUS) Thalamotomy
- Osseoanchored Prostheses for the Rehabilitation of Amputees (OPRA) Implant System for Transfemoral Amputations
- Pneumatic Compression Devices for Lymphedema
- Proton Beam Therapy
- Sacral Neuromodulation
- Thermal Evacuation Therapy and Intense Pulsed Light Therapy for Meibomian Gland Dysfunction
- Thread Carpal Tunnel Release
- Total Artificial Heart
- Transurethral Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia
- Transurethral Waterjet Ablation for Benign Prostatic Hyperplasia
- Tumor Treating Fields (TTFs) Therapy
- Ultrasound-Guided Radiofrequency Ablation for Uterine Fibroids
- Wearable Cardioverter Defibrillator
Terms and Definitions
Each clinical determination and indication contains the following terms and associated definitions:
- Effective date: Date the community care medical policy is effective.
- Exclusion criteria: Characteristics that disqualify prospective Veterans from care pathways or prescriptions.
- Experimental or Investigational: A treatment, procedure, equipment, drug, or service that has not been determined to be medically effective for the condition being treated but may be part of a research study to evaluate if the condition improves with use.
- Facility: The service is performed in a facility setting (i.e., hospital, ambulatory or surgical center).
- Facility type: Hospital or other institution where outpatient and inpatient services are performed.
- FDA approval: To receive U.S. Food and Drug Administration (FDA) approval, drug manufacturers must conduct testing and submit their data to FDA. FDA may approve the drug if the agency determines the benefits of the drug outweigh the risks for intended use.
- Locality description: Place of service locality (e.g., city, county).
- Medical necessity: Health care services that can be justified as reasonable, necessary and appropriate based on evidence-based clinical standards of care.
- Medicare carrier: Identification number assigned by Centers of Medicare and Medicaid Services (CMS) to a carrier (Medicare Administrative Contractor) authorized to process claims from a physician or supplier.
- Medicare locality: Identification number assigned by the CMS for a locality where care is received.
- Non-facility: The service is performed in a non-facility setting (i.e., physician’s office or outpatient clinic).
- Policy number: A unique ID code that combines an abbreviation of the name and version number.
- Procedure: Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) codes are industry standard codes used to identify specific surgical, medical, or diagnostic interventions.
- Procedure code modifier: Supplemental information or “adjust care” descriptions to provide extra detail concerning a procedure or service.
Contacts
Questions?
Complete the form below to submit a question about a published CDI to the IVC Clinical Determinations Unit (CDU).
Note: This process is not to be used to submit a Request for Service (RFS), Form 10-10172. Instructions for the RFS process are on the Care Coordination Overview page.