VA Fee Schedule - Community Care
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VA Fee Schedule

IMPORTANT UPDATE: Beginning January 1, 2021, VA will use a new approach for fee schedule rate establishment. See 2021 Fee Schedule below.

What is Changing: VA is updating its fee schedule calculations to align with industry best practices and will now calculate the payment rate based on the location where the care is provided (i.e. rendering locality). Previously, the VA fee scheduled calculated the payment rates based on the location of the referring VA Medical Center.

How this impacts you: Your payment rate may be different under the new calculations based on the location where the care is provided.

VA generally reimburses hospital care, medical services and extended services at the applicable Medicare rate published by the Centers for Medicare and Medicaid Services (CMS). When no CMS rate is available, VA and Third Party Administrators (TPAs) reimburse at the lesser amount of (1) billed charges or (2) the VA Fee Schedule rate. The VA Fee Schedule rate is the amount published for the designated date of service time period.

Please Note:

  • Alaska VA Fee Schedule and methodology is an exception. Alaska providers, please review the specific information below for care rendered in the state of Alaska.
  • VA’s dental schedule is not publicly available due to the terms of VA’s contract for compiling a dental services fee schedule.
  • Reimbursement rates are subject to change annually and more often if required. Check this page regularly to find the latest rates, and sign up for our VA Provider Advisor newsletter to be informed of rate updates.

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VA Fee Schedule Data Definitions
  • CPT/HCPCS Code: Industry standard codes, some including modifiers
  • Facility: A hospital or other institution where outpatient and inpatient services are performed
  • Modifier: supplemental information or adjust care descriptions to provide extra detail concerning a procedure or service
  • Network: A group or system; for VA purposes a Network is identified as one of the following: Veteran Affairs Payment, TriWest or Optum
  • Procedure: code used to identify specific surgical, medical, or diagnostic intervention
  • Rate: Reimbursement amount based on rendering location or referring VA facility
  • Referral: VA Form 10-7080, Approved Referral for Medical Care, which authorizes a community provider to render healthcare to a Veteran at VA expense. VA referrals may be issued through TriWest, Optum or VA
  • Station Number: VA numerical identifier for a specific VA facility
  • VISN: Veterans Integrated Service Network
Alaska Providers

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

Community Care Network (CNN) is the preferred national network VA uses to purchase care for Veterans in the community. Care referred through CCN in Alaska is billed to and paid by VA’s Third-party Administrator, TriWest. Care referred and/or purchased outside of CCN is billed to and paid by VA. Please refer to the VA referral for information on how care is referred and where to submit claims. Schedules and payment rates may be impacted depending on whether the care has been approved through CCN. Please refer to the appropriate section below based upon how care has been referred to you.

Community Care Network (CCN) 5

Physician and non-physician professional services approved through CCN and rendered in Alaska will be paid by TriWest in accordance with the (1.) Alaska Professional Fee schedule. Hospital care, medical services and extended services not covered by the Alaska Professional Fee schedule will be paid at the applicable (2.) Medicare rate published by the Centers for Medicare and Medicaid Services (CMS). When no CMS rate is available, TriWest will reimburse at the (3.) VA Fee Schedule rate for the designated date of service time period. Under no circumstances will TriWest payment exceed rates published in the (4.) Maximum Allowable Charge schedule.

Non-CCN

Physician and non-physician professional services approved through a Veteran’s Care Agreement (VCA) and rendered in Alaska will be paid by VA in accordance with the (1.) Alaska Professional Fee schedule. Hospital care, medical services and extended services not covered by the Alaska Professional Fee schedule will be paid at the applicable (2.) Medicare rate published by the Centers for Medicare and Medicaid Services (CMS). When no CMS rate is available, VA will reimburse at the (3.) lesser amount of (1) billed charges or (2) the VA Fee Schedule rate for the designated date of service time period.

2021 Fee Schedule

VA Fee Schedule–All Payers

Which rate applies to me?

  1. Open the 2021 Fee Schedule file above.
  2. Identify the service to include modifier (if applicable).
  3. Identify the Medicare locality and carrier for the location where services were rendered.
    • Providers needing assistance with identification of locality and carrier information are encouraged to refer to the appropriate CMS locality and carrier key available at CMS.gov Centers for Medicare & Medicaid Services website.

      Centers for Medicare & Medicaid Services
  4. Identify the setting in which care was rendered
    • For care rendered in a facility setting, refer to the ‘Yes’ column for reimbursement rate.
    • For care rendered in a setting other than a facility, refer to the ‘No’ column for reimbursement rate.
2020 Fee Schedules

Which rate applies to me?

  1. Determine which type of care was provided.
    • For selected home and community-based services, open the VA Geriatric and Extended Care (GEC) Fee Schedule 2020.
    • For non-home and community-based services, open the VA Fee Schedule (non-GEC) 2020.
  2. Identify the VA facility that issued the referral.
  3. Identify the CPT/HCPCS code and rate.

Frequently Asked Questions

How do I determine which rate applies to me?

Dates of service January 1, 2021 and after:

  • Open the VA Fee Schedule–All Payers file above.
  • Identify the Medicare locality and carrier for the location where services were rendered.
  • Identify if the services were rendered in a facility or non-facility setting.

Dates of service prior to January 1, 2021:

  • For non-GEC services, open the VA Fee Schedule (non-GEC) file above.
  • For GEC services, open the GEC Fee Schedule file above.
  • Identify the VA facility that issued the referral.
Which services are included in this fee schedule?

Physician care, hospital care, clinical laboratory, ambulance, and drug services.

How often does VA publish an updated fee schedule?

VA publishes fee schedules annually and may publish additional updates as appropriate. To get the latest updates on VA community care and the latest fee schedule rates, please sign up for VA Provider Advisor newsletter.

Sign up for the Provider Advisor newsletter

How do I download the fee schedule files?

Click on the VA Fee Schedule–All Payers link above and select ‘Save As.’

Contact Us

TriWest Customer Service: 855-722-2838

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

VA Customer Service: 877-881-7618

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