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Spina Bifida Health Care Benefits Program–Information for Providers

icon spineThe Spina Bifida Health Care Benefits Program (SBHCBP) is a health benefits program administered by VA for Vietnam and certain Korean Veterans’ birth children who have been diagnosed with spina bifida (except spina bifida occulta). Under the Spina Bifida Program, comprehensive health care considered medically necessary and appropriate is covered.

To be eligible for the Spina Bifida Health Care Benefits Program, a child must first be eligible for a monetary award under the Veterans Benefits Administration (VBA). The Denver VA Regional Office makes the determination regarding that entitlement. The VBA notifies the Office of Community Care after they have made a monetary award, and enrollment in the Spina Bifida Health Care Program is automatic.

To participate in the SBHCBP, providers must be properly licensed in their state and must not be on the Medicare exclusion list. Additionally, providers must accept the VA-determined allowable amount for care.

Spina Bifida Claims

Providers should use a standard billing form (UB-04/CMS 1500) to provide required information. For information about filing claims for payments, including a list of required documentation, review How to File a Claim for the Spina Bifida Health Care Benefits Program.

How to File a SBHCBP Claim

Preauthorization is required for the following:

  • Attendants
  • Day health care as an outpatient service
  • Dental services
  • Durable medical equipment (DME) in excess of $2,000
  • Homemaker services (must be health-related services)
  • Outpatient mental health services in excess of 23 visits per calendar year
  • Substance abuse treatment
  • Training of family members, guardians and members of the child's household
  • Transplantation services
  • Travel (other than mileage for local travel) in private automobiles at the general services administration rate

Send preauthorization requests to:

Fax: 303-331-7807

VHA Office of Community Care/Spina Bifida
ATTN: Preauthorization
PO Box 469065, Denver CO 80246-9065

Contacts

Customer Service Center: 888-820-1756

Paper Claims:
VHA Office of Community Care
Spina Bifida Health Care Benefits Program
PO Box 469065
Denver CO 80246-9065