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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 (PDF | Web)
- V4.225 Reasonable Charges Federal Register Notice, 01/01/2022 (Outpatient and Professional)
V4.225 FR PDF | V4.225 FR WEB - V4.22 Reasonable Charges Federal Register Notice, 10/1/2021 (Inpatient)
V4.22 FR PDF | V4.22 FR WEB - V4.215 Reasonable Charges Federal Register Notice, 01/01/2021 (Outpatient and Professional)
V4.215 FR PDF | V4.215 FR WEB - 38 CFR 17.100 Provider-Based Requirements Final Rule, 10/01/2020
38 CFR 17.100 PDF | 38 CFR 17.100 WEB - V4.21 Reasonable Charges Federal Register Notice, 10/01/2020 (Inpatient)
V4.21 FR PDF | V4.21 FR WEB - V3.27 Reasonable Charges Federal Register Notice, 01/01/20 (Outpatient and Professional)
V3.27 FR PDF | V3.27 FR WEB - V3.26 Reasonable Charges Federal Register Notice, 10/01/19 (Inpatient)
V3.26 FR PDF | V3.26 FR WEB - V3.25 Reasonable Charges Federal Register Notice, 01/01/19 (Outpatient and Professional)
V3.25 FR PDF | V3.25 FR WEB - V3.24 Reasonable Charges Federal Register Notice, 10/01/18 (Inpatient)
V3.24 FR PDF | V3.24 FR WEB - V3.23 Reasonable Charges Federal Register Notice, 01/01/18 (Outpatient and Professional)
V3.23 FR PDF | V3.23 FR WEB - V3.22 Reasonable Charges Federal Register Notice, 10/01/17 (Inpatient)
V3.22 FR PDF | V3.22 FR WEB - V3.21 Reasonable Charges Federal Register Notice, 01/01/17 (Outpatient and Professional)
V3.21 FR PDF | V3.21 FR WEB - V3.19 Reasonable Charges Federal Register Notice, 10/01/16 (Inpatient)
V3.19 FR PDF | V3.19 FR WEB - V3.18 Reasonable Charges Federal Register Notice, 01/01/16 (Outpatient and Professional)
V3.18 FR PDF | V3.18 FR WEB - V3.17 Reasonable Charges Federal Register Notice, 10/01/15 (Inpatient)
V3.17 FR PDF | V3.17 FR WEB - V3.16 Reasonable Charges Federal Register Notice, 01/01/15 (Outpatient and Professional)
V3.16 FR PDF | V3.16 FR WEB
Reasonable Charges Data Tables (Excel)
v4.23 Inpatient Reasonable Charges (October 2022–December 2023)
- V4.23 Data Table A (Acute Inpatient Facility Nationwide Per Diem Charges by Medicare Severity Diagnosis Related Group)
- V4.23 Data Table B (Skilled Nursing Facility/Sub-Acute Inpatient Facility Nationwide Per Diem Charge)
V4.225 Outpatient Reasonable Charges (January 2022–December 2022)
v4.22 Inpatient Reasonable Charges (October 2021–September 2022)
- V4.22 Data Table A (Acute Inpatient Facility Nationwide Per Diem Charges by Medicare Severity Diagnosis Related Group)
- V4.22 Data Table B (Skilled Nursing Facility/Sub-Acute Inpatient Facility Nationwide Per Diem Charge)
V4.215 Outpatient Reasonable Charges (January 2021–December 2021)
v4.21 Inpatient Reasonable Charges (October 2020–September 2021)
- V4.21 Data Table A (Acute Inpatient Facility Nationwide Per Diem Charges by Medicare Severity Diagnosis Related Group)
- V4.21 Data Table B (Skilled Nursing Facility/Sub-Acute Inpatient Facility Nationwide Per Diem Charge)
Previous Inpatient Reasonable Charges
Reasonable Charges Data Sources (Excel & PDF)
Excel files
- V4.23 Reasonable Charges Data Sources (Inpatient)
- V4.225 Reasonable Charges Data Sources (Outpatient and Professional), 01/01/2022
- V4.22 Reasonable Charges Data Sources (Inpatient)
- V4.215 Reasonable Charges Data Sources (Outpatient and Professional)
- V4.21 Reasonable Charges Data Sources (Inpatient)
PDF documents
- V3.27 Reasonable Charges Data Sources (Outpatient and Professional)
- V3.26 Reasonable Charges Data Sources (Inpatient)
- V3.25 Reasonable Charges Data Sources (Outpatient and Professional)
- V3.24 Reasonable Charges Data Sources (Inpatient)
- V3.23 Reasonable Charges Data Sources (Outpatient and Professional)
- V3.22 Reasonable Charges Data Sources (Inpatient)
- V3.21 Reasonable Charges Data Sources (Outpatient and Professional)
- V3.19 Reasonable Charges Data Sources (Inpatient)
- V3.18 Reasonable Charges Data Sources (Outpatient and Professional)
- V3.17 Reasonable Charges Data Sources (Inpatient)
- V3.16 Reasonable Charges Data Sources (Outpatient and Professional)
VA Medical Facility Locations (PDF)
- VA Medical Facility Locations, V4.23 (OCT 2022)
- VA Medical Facility Locations, V4.225 (JAN 2022)
- VA Medical Facility Locations, V4.22 (OCT 2021)
- 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)
Cost-Based and Interagency Rate (PDF | Web)
- Cost-Based and Interagency Federal Register Notice, 10/01/22 (PDF | WEB)
- Cost-Based and Interagency Federal Register Notice, 10/01/21 (PDF | WEB)
- Cost-Based and Interagency Federal Register Notice, 10/01/20 (PDF | WEB)
- Cost-Based and Interagency Federal Register Notice, 10/01/19 (PDF | WEB)
- Cost-Based and Interagency Federal Register Notice, 08/28/18 (PDF | WEB)
- Cost-Based and Interagency Federal Register Notice, 08/29/17 (PDF | WEB)
Third Party Pharmacy Prescription Administrative Charge
Average national administrative cost for prescriptions for CY 2014 through CY 2022 can be viewed at Average Administrative Cost for Prescriptions.
