VA Fee Schedule - Community Care
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VA Fee Schedule

This webpage contains reimbursement rates for inpatient and outpatient health care professional services subject to the Department of Veterans Affairs (VA) Fee Schedule.

For inpatient and outpatient health care professional services and other medical charges covered by a Veterans Care Agreement (VCA), VA reimburses at the applicable Medicare rate published by the Centers for Medicare and Medicaid Services (CMS). When there is no Medicare rate and there is a VA Fee Schedule amount available, VA reimburses at the lesser of billed charges or the local VA Fee Schedule amount for the period in which the service was performed.

NOTE: In accordance with the terms of VA’s contract for compiling a dental services fee schedule, said schedule is not publicly available.

VA will publish fee schedules annually and may publish additional updates when needed. Below are links to download the current schedule along with archived schedules as new versions are released.

VA Fee Schedule Data Definitions

  • VA VISN: Veterans Affairs Veterans Integrated Service Network
  • Station Number: VA numerical identifier for a specific VA location
  • Facility Name: Geographic location of VA facility
  • CPT Code: Industry standard codes, some including modifiers
  • Rate: Location specific VA reimbursement rate
  • Fiscal Year: Fiscal year for which rates are applicable

Upcoming Calendar Year Fee Schedules (rates effective 01/01/21)

Locality Rates (Community Care Network reimbursement and authorized Emergency Care claims), posted November 30, 2020

Station Rates (for unauthorized Emergency Care claims and PC3 claims), posted November 30, 2020

Alaska Locality Rates (for facility care rendered in Alaska), posted November 30, 2020

Current Year Fee Schedules (rates effective 10/01/19)

Current FY20 Geriatrics and Extended Care Fee Schedule for selected Home and Community-based Services, posted October 15, 2020
(The fee schedule rates in this file replace those for selected Home and Community-Based Services previously posted in the Current FY20 National Fee Schedule, posted May 4, 2020)

Current FY20 National Fee Schedule, posted May 04, 2020

Archived/Previous Fee Schedules

FY20 National Fee Schedule–MAR 2020

FY20 National Fee Schedule–OCT 2019

Frequently Asked Questions

How do I download the Fee Schedule files?

Right click on the Fee Schedule link and select save. Then save the file to a location on your computer.

Which services are included in this fee schedule?

This schedule includes rates for physician, clinical laboratory, ambulance, and drug services.

How do I determine which locality applies to me?

For care beginning on or after January 1, 2021, rates are specific to the geographic area where care is rendered.

How often will VA publish an updated fee schedule version?

VA will publish fee schedules annually and may publish additional updates when needed.

Why have acupuncture rates recently changed?

For Veterans Care Agreements (VCAs) and Community Care Network (CCN), VA payment methodology applies the following hierarchy:

  • In the absence of a specific contracted rate, VA reimburses at the applicable Medicare rate published by the Centers for Medicare and Medicaid Services (CMS).
  • When there is no Medicare rate, VA reimburses the local VA Fee Schedule (VAFS).

Recently, rates for acupuncture have changed. Some acupuncture treatments did not have Medicare rates until January 2020. Prior to January 2020, if there was not a Medicare rate, the VA Fee Schedule (VAFS) was used. After the Medicare rates for acupuncture went into effect, it became VA’s new payment rate based on VA payment methodology through the VCAs and CCN contracts. This is standard procedure when CMS publishes a new rate.

In the CMS fee schedule, there is a difference in reimbursement rate between licensed independent practitioners (LIPs) and mid-level providers (the latter receiving a lower payment rate). VA has made the decision to pay all acupuncture providers at the CMS reimbursement rate for LIPs.

The VAFS amount is determined by analyzing provider billings within specific localities, which ranks all billings under the corresponding procedure code during the previous fiscal year, with billings ranked from the highest to the lowest. The VAFS is provided to CCN Third Party Administrators (TPAs) to use in processing VA claims.

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