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Payer Rates and Charges
Reasonable Charges are based on amounts that third parties pay for the same services furnished by private-sector health care providers in the same geographic area. In the past, VA used average cost-based, per diem rates for billing insurers. Reasonable charges are calculated for inpatient and outpatient facility charges, and for professional or clinician charges for inpatient and outpatient care.
Reasonable Charges Rules, Notices, & Federal Register
- Reasonable Charges 38 CFR 17.101 VA Billing and Collections Final Rule, 03/26/2021
(38 CFR 17.101 Web) - Reasonable Charges V4.215 Federal Register Notice, 1/1/2021(Outpatient and Professional)
(V4.215 FR Web) - Reasonable Charges 38 CFR 17.100 Provider Based Requirement Final Rule, 10/01/2020
(38 CFR 17.100 Web) - Reasonable Charges V4.21 Federal Register Notice, 10/1/2020 (Inpatient)
(V4.21 FR Web) - Reasonable Charges V3.27 Federal Register Notice, 01/01/20 (Outpatient and Professional)
(V3.27 FR Web) - Reasonable Charges V3.26 Federal Register Notice, 10/01/19 (Inpatient)
(V3.26 FR Web) - Reasonable Charges V3.25 Federal Register Notice, 01/01/19 (Outpatient and Professional)
(V3.25 FR Web) - Reasonable Charges V3.24 Federal Register Notice, 10/01/18 (Inpatient)
(V3.24 FR Web) - Reasonable Charges V3.23 Federal Register Notice, 01/01/18 (Outpatient and Professional)
(V3.23 FR Web) - Reasonable Charges V3.22 Federal Register Notice, 10/01/17 (Inpatient)
(V3.22 FR Web) - Reasonable Charges V3.21 Federal Register Notice, 01/01/17 (Outpatient and Professional)
(V3.21 FR Web) - Reasonable Charges V3.19 Federal Register Notice, 10/01/16 (Inpatient)
(V3.19 FR Web) - Reasonable Charges V3.18 Federal Register Notice, 01/01/16 (Outpatient and Professional)
(V3.18 FR Web) - Reasonable Charges V3.17 Federal Register Notice, 10/01/15 (Inpatient)
(V3.17 FR Web) - Reasonable Charges V3.16 Federal Register Notice, 01/01/15 (Outpatient and Professional)
(V3.16 FR Web) - Reasonable Charges V3.15 Federal Register Notice, 10/01/14 (Inpatient)
(V3.15 FR Web) - Reasonable Charges V3.14 Federal Register Notice, 01/01/14 (Outpatient and Professional)
(V3.14 FR Web)
Reasonable Charges Data Tables
- V4.215 Data Tables (Outpatient and Professional)
- Table C: Observation Care Facility Nationwide Base and Hourly Charges
- Table D: Partial Hospitalization Facility Nationwide Per Diem Charge
- Table E: Ambulance and Other Emergency Transportation Charges by HCPCS Code
- Table F: Outpatient Facility Nationwide Charges by CPT/HCPCS Code
- Table G: Physician and Professional Services Relative Value Units (RVUs) by CPT/HCPCS Code
- Table H: Professional Anesthesia Nationwide Base Units by CPT Code
- Table I: Outpatient Dental Professional Nationwide Charges by HCPCS Code
- Table J: Pathology and Laboratory Services Relative Value Units (RVUs)
- Table K: Durable Medical Equipment and Supplies Nationwide Charges by HCPCS Code
- Table L: Professional Services RVU Conversion Factor GAAFs by Zip Code
- Table M: Charge Adjustment Factors for Professional Services Charge Modifiers
- Table N: Acute Inpatient Facility Charges GAAFs by Zip Code
- Table O: Skilled Nursing Facility/Sub-Acute Inpatient Facility Charges GAAFs by Zip Code
- Table P: Outpatient Facility Charges Geographic Area Adjustment Factors (GAAFs) by Zip Code
- Table Q: Durable Medical Equipment and Supplies GAAFs by Zip Code
- Table R: Outpatient Dental Professional Charges GAAFs by Zip Code
- Table S: Professional Services Conversion Factors
- V4.21 Data Table A (Inpatient) | V4.21 Data Table B (Inpatient)
- V3.27 Data Tables (Outpatient and Professional)
- V3.26 Data Tables (Inpatient)
- V3.25 Data Tables (Outpatient and Professional)
- V3.24 Data Tables (Inpatient)
- V3.23 Data Tables (Outpatient and Professional)
- V3.22 Data Tables (Inpatient)
- V3.21 Data Tables (Outpatient and Professional)
- V3.19 Data Tables (Inpatient)
- V3.18 Data Tables (Outpatient and Professional)
- V3.17 Data Tables (Inpatient)
- V3.16 Data Tables (Outpatient and Professional)
- V3.15 Data Tables (Inpatient)
- V3.14 Data Tables (Outpatient and Professional)
Reasonable Charges Data Sources
- Reasonable Charges V4.215 Data Sources (Outpatient and Professional)
- Reasonable Charges V4.21 Data Sources (Inpatient)
- Reasonable Charges V3.27 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.26 Data Sources (Inpatient)
- Reasonable Charges V3.25 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.24 Data Sources (Inpatient)
- Reasonable Charges V3.23 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.22 Data Sources (Inpatient)
- Reasonable Charges V3.21 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.19 Data Sources (Inpatient)
- Reasonable Charges V3.18 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.17 Data Sources (Inpatient)
- Reasonable Charges V3.16 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.15 Data Sources (Inpatient)
- Reasonable Charges V3.14 Data Sources (Outpatient and Professional)
VA Medical Facility Locations
- VA Medical Facility Locations, V4.215 (JAN 2021)
- VA Medical Facility Locations, V4.21 (OCT 2020)
- VA Medical Facility Locations, V3.27 (JAN 2020)
- VA Medical Facility Locations, V3.26 (OCT 2019)
- VA Medical Facility Locations, V3.25 (JAN 2019)
- VA Medical Facility Locations, V3.24 (OCT 2018)
- VA Medical Facility Locations, V3.23 (JAN 2018)
- VA Medical Facility Locations, V3.22 (OCT 2017)
- VA Medical Facility Locations, V3.21 (JAN 2017)
- VA Medical Facility Locations, V3.19 (OCT 2016)
- VA Medical Facility Locations, V3.18 (JAN 2016)
- VA Medical Facility Locations, V3.17 (OCT 2015)
- VA Medical Facility Locations, V3.16 (JAN 2015)
- VA Medical Facility Locations, V3.15 (OCT 2014)
- VA Medical Facility Locations, V3.14 (JAN 2014)
Cost-Based and Interagency Rate
- Cost-Based and Interagency Federal Register Notice, 10/01/20 | (Web)
- Cost-Based and Interagency Federal Register Notice, 10/01/19 | (Web)
- Cost-Based and Interagency Federal Register Notice, 08/28/18 | (Web)
- Cost-Based and Interagency Federal Register Notice, 08/29/17 | (Web)
- Cost-Based and Interagency Federal Register Notice, 07/07/16 | (Web)
Third Party Pharmacy Prescription Administrative Charge
Average national administrative cost for prescriptions for CY 2014 through CY 2020 can be viewed at Average Administrative Cost for Prescriptions.
