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Community Care

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VA Fee Schedule for Authorized Community Care

VA Fee Schedule (VAFS) rates are used for authorized community care in the absence of a contract-negotiated rate or Medicare rate. VA reimburses hospital, medical, and extended care services up to the maximum allowable rate. This page explains how VA determines reimbursement rates, how to locate applicable VAFS rates, and what exceptions providers should be aware of.

How VA determines payment rates

When reimbursing for authorized community care, VA uses the following order to decide which rate applies:

  1. Contract-negotiated rate: If a contract-negotiated rate exists, that rate is used.
  2. Medicare rate: If no contract-negotiated rate is available, VA uses the Medicare rate published by the Centers for Medicare & Medicaid Services (CMS), including Medicare Administrative Contractor (MAC) rates.
  3. VA Fee Schedule rate: If contract-negotiated and Medicare rates are not available, VA applies the VAFS rate.
  4. Percentage of billed charges: If no other rate applies, VA reimburses a percentage of the provider’s billed amount.

Programs and types of care that do not use VAFS

The VA Fee Schedule does not apply to all types of authorized care. Two exceptions are:

  • CHAMPVA, the Civilian Health and Medical Program of the Department of Veterans Affairs, operates under its own reimbursement policies and does not use the VA Fee Schedule. Providers serving CHAMPVA beneficiaries should follow CHAMPVA-specific billing guidance.
  • Dental services are reimbursed using proprietary rates. For CCN referrals, contact the third-party administrator (TPA) for your region. For non-CCN referrals, contact the referring VA Medical Center (VAMC).

Important considerations for VA payment rates

Reimbursement rates do not imply coverage
A published rate, whether from CMS or VAFS, does not imply that a service is covered or not covered. It only indicates how a service may be reimbursed if it is authorized and determined to be separately payable.

Authorized services only
VA reimburses only for services explicitly authorized in the VA-approved referral. Providers should confirm that all care delivered falls within the scope of the referral. For questions, contact the VA medical center that issued the referral.

Referral type may affect reimbursement
Reimbursement rates may differ depending on how care was approved. Refer to the terms of your contract and the VA Approved Referral for details.

Reimbursement may be limited to the amount
Depending on the contract, VA may pay whichever is less: the agreed-upon rate or the amount the provider bills.

Alaska providers
Providers in Alaska are subject to unique reimbursement considerations. Refer to the Alaska VA Fee Schedules for more information.

Non-Reimbursable Codes List
The Non-Reimbursable Codes List contains procedure codes VA has deemed ineligible for payment.

Clinical coverage information
For current VA coverage decisions and clinical guidance, visit the Clinical Determinations and Indications webpage.

Clinical Determinations and Indications–Information for Providers

Fee Schedules

VAFS reimbursement rates are updated annually and may change more frequently if needed. Providers are encouraged to check this page regularly for the latest rates.

How to Determine which VAFS Rate Applies

  1. Open the applicable VA fee schedule file.
  2. Identify the service and include any applicable modifiers.
  3. Identify the Medicare locality and carrier for the location where services were rendered.
    • Providers who need help identifying locality and carrier information can refer to the appropriate CMS locality and carrier key on the CMS.gov website.

Centers for Medicare & Medicaid Services

  1. Identify the setting where care was provided.
    • For care provided in a facility, refer to the ‘Facility Rate’ column for reimbursement rate.
    • For care provided in a non-facility setting, refer to the ‘Non-Facility Rate’ column for reimbursement rate.

Fee Schedule Files

2026 VA Fee Schedule

The 2026 VA Fee Schedule is effective for services from January 1, 2026, to December 31, 2026.

CY26 VA Fee Schedule-All Payers

2026 Alaska Fee Schedule

Certain community services provided to Veterans in the state of Alaska are subject to specific fee schedules. These account for the unique cost of providing care in that geographic area.

VA will increase the amounts on the Alaska VA Fee Schedule each year based on the published national Medicare Economic Index. For those years where the annual average of this index is a negative percentage, the Alaska VA Fee Schedule will remain the same as the previous year.

2026 Alaska Professional Fee Schedule (Effective for Physician and Non-Physician professional services on or after January 1, 2026)

2026 Alaska VA Fee Schedule (Effective for services on or after January 1, 2026)

Community Nursing Home (CNH) Fee Schedule (effective October 1, 2025)

The VA CNH Fee Schedule is only applicable for services authorized under Veterans Care Agreements (VCA) and Indefinite Delivery Indefinite Quantity (IDIQ) contracts that use VA’s Patient Driven Payment Model (PDPM) for reimbursement. The VA CNH Fee Schedule follows the Prospective Payment System (PPS) billing requirements found in Medicare Claims Processing Manual, Chapter 6–Skilled Nursing Facility (SNF) Inpatient Part A Billing and SNF Consolidated Billing. This includes the interrupted stay policy and enhanced payments for HIV/AIDS. Exceptions are listed below.

Medicare Claims Processing Manual, Chapter 6

Exceptions:

  1. VA pays the lesser of billed charges or the CNH Fee Schedule.
  2. VA will use the Patient Driven Payment Model-based (PDPM) pricing software using the following specifications:
    1. CNH day 1-100: multiply physical therapy (PT), occupational therapy (OT), speech language pathology (SLP), nursing and non-case-mix components by 0.93 in addition to any other adjustment factors.
    2. CNH day 101+: remove PT, OT, and SLP components (or set adjustment factor to 0). Multiply nursing and non-case-mix components by 1.25.
    3. The non-therapy ancillary component will follow PDPM (3.0 for the first three days, and 1.0 for CNH days 4-100 and 1.25 for CNH day 101+).
  3. No special service pricing exists outside of VA PDPM-based PPS for services such as bed hold, memory care, behavioral, respite, ventilator, tracheostomy and isolation/private room.
  4. VA does not participate in the value-based program.
  5. VA covers some services under CNH authorizations that are not considered part of the nursing home PPS. Nursing homes are required to submit separate claims for these services listed below.
    1. Physician Services: Providers delivering federally mandated or separately authorized services shall bill fee-for-service. The services will be reimbursed at the lesser of billed charges or the Medicare Physician Fee Schedule.
    2. PT, OT and SLP: When PT, OT or SLP therapy is required during days 101+ of a Veteran’s stay, providers must get prior authorization from VA. When care is delivered on days 101+ of a Veteran’s stay, providers will bill fee-for-service using the following procedure codes: G0151, G0152, G0153, G0157, G0158, G0159, G0160, G0161. The services will be reimbursed at the lesser of billed charges or the VA Fee Schedule.
    3. Escort Services: When an escort to a medical appointment is indicated, providers must get prior authorization from VA. Providers will bill fee-for-service using the following procedure code: G0156. The services paid will be the lesser of billed charges or the VA Fee Schedule.
Non-Reimbursable Codes List

The Non-Reimbursable Codes List contains procedure codes VA has deemed ineligible for payment. The list includes effective and end dates for each code based on dates of service, indication of changes to past decisions, and current statuses.

VA Non-Reimbursable Codes List

Historical Fee Schedules

2025 Fee Schedules

2024 Fee Schedules

2023 Fee Schedules

*VA adjusted the yearly fee schedule update cycle to ensure rate settings consider comprehensive data from other sources. Beginning in 2023, the fee schedule cycle ran February 1 to January 31. To accommodate the adjustment, the CY22 VA Fee Schedule–All Payers service dates ran through January 31, 2023.

2022 Fee Schedules

2021 Fee Schedules

VA Fee Schedule Data Definitions
  • Facility: The service is performed in a facility setting (for example, hospital, ambulatory or surgical center).
  • Facility type: A hospital or other institution where outpatient and inpatient services are performed.
  • Locality Description: Name of locality place of service (for example, city or county).
  • Medicare Carrier: The identification number assigned by CMS to a carrier (Medicare Administrative Contractor) authorized to process claims from a physician or supplier.
  • Medicare Locality: The identification number assigned by CMS to a locality used to identify where care is rendered.
  • Non-Facility: The service is performed in a non-facility setting (for example, physician’s office or outpatient clinic).
  • Procedure: Current Procedural Terminology/ Healthcare Common Procedure Coding System Industry standard codes used to identify specific surgical, medical or diagnostic intervention.
  • Procedure Code Modifier: Supplemental information or adjust care descriptions to provide extra detail concerning a procedure or service.
  • Rate: Reimbursement amount based on where care is rendered.

VAFS Feedback

We welcome provider feedback on the VA Fee Schedules. While individual responses are not guaranteed, all submissions are reviewed and may help inform future updates.
IMPORTANT: Do not include any Personally Identifiable Information (PII) or Personal Health Information (PHI).

VA Fee Schedule Feedback

Federal Register Notice

See the March 2024 Federal Register Notice, Methodology for Reimbursing Medical Services, Extended Care Services, Pharmaceuticals, and Durable Medical Equipment Not on Medicare Fee Schedules, for more information on how VA Fee Schedule rates are established.

March 2024 Federal Register Notice

Contact Us

VA Customer Service: 877-881-7618

Optum Customer Service:
CCN Region 1: 888-901-7407
CCN Region 2: 844-839-6108
CCN Region 3: 888-901-6613

TriWest Customer Service: 877-226-8749

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