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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 V4.225 Federal Register Notice, 01/01/2022 (Outpatient and Professional)
(V4.225 FR Web) - Reasonable Charges V4.22 Federal Register Notice, 10/1/2021 (Inpatient)
(38 CFR 17.101 Web) - Reasonable Charges V4.215 Federal Register Notice, 01/01/2021 (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, 10/01/2020 (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 Data Tables
- V4.225 Data Tables (Outpatient and Professional), 01/01/2022
- V4.225 Table C: Observation Care Facility Nationwide Base and Hourly Charges
- V4.225 Table D: Partial Hospitalization Facility Nationwide Per Diem Charge
- V4.225 Table E: Ambulance and Other Emergency Transportation Charges by HCPCS Code
- V4.225 Table F: Outpatient Facility Nationwide Charges by CPT/HCPCS Code
- V4.225 Table G: Physician and Professional Services Relative Value Units (RVUs) by CPT/HCPCS Code
- V4.225 Table H: Professional Anesthesia Nationwide Base Units by CPT Code
- V4.225 Table I: Outpatient Dental Professional Nationwide Charges by HCPCS Code
- V4.225 Table J: Pathology and Laboratory Services Relative Value Units (RVUs)
- V4.225 Table K: Durable Medical Equipment and Supplies Nationwide Charges by HCPCS Code
- V4.225 Table L: Professional Services RVU Conversion Factor Geographic Area Adjustment Factors (GAAFs) by Zip Code
- V4.225 Table M: Charge Adjustment Factors for Professional Services Charge Modifiers
- V4.225 Table N: Acute Inpatient Facility Charges GAAFs by Zip Code
- V4.225 Table O: Skilled Nursing Facility/Sub-Acute Inpatient Facility Charges GAAFs by Zip Code
- V4.225 Table P: Outpatient Facility Charges GAAFs by Zip Code
- V4.225 Table Q: Durable Medical Equipment and Supplies GAAFs by Zip Code
- V4.225 Table R: Outpatient Dental Professional Charges GAAFs by Zip Code
- V4.225 Table S: Professional Services Conversion Factors
- V4.215 Data Tables (Outpatient and Professional), 01/01/2021
- V4.215 Table C: Observation Care Facility Nationwide Base and Hourly Charges
- V4.215 Table D: Partial Hospitalization Facility Nationwide Per Diem Charge
- V4.215 Table E: Ambulance and Other Emergency Transportation Charges by HCPCS Code
- V4.215 Table F: Outpatient Facility Nationwide Charges by CPT/HCPCS Code
- V4.215 Table G: Physician and Professional Services Relative Value Units (RVUs) by CPT/HCPCS Code
- V4.215 Table H: Professional Anesthesia Nationwide Base Units by CPT Code
- V4.215 Table I: Outpatient Dental Professional Nationwide Charges by HCPCS Code
- V4.215 Table J: Pathology and Laboratory Services Relative Value Units (RVUs)
- V4.215 Table K: Durable Medical Equipment and Supplies Nationwide Charges by HCPCS Code
- V4.215 Table L: Professional Services RVU Conversion Factor Geographic Area Adjustment Factors (GAAFs) by Zip Code
- V4.215 Table M: Charge Adjustment Factors for Professional Services Charge Modifiers
- V4.215 Table N: Acute Inpatient Facility Charges GAAFs by Zip Code
- V4.215 Table O: Skilled Nursing Facility/Sub-Acute Inpatient Facility Charges GAAFs by Zip Code
- V4.215 Table P: Outpatient Facility Charges GAAFs by Zip Code
- V4.215 Table Q: Durable Medical Equipment and Supplies GAAFs by Zip Code
- V4.215 Table R: Outpatient Dental Professional Charges GAAFs by Zip Code
- V4.215 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)
Reasonable Charges Data Sources
- Reasonable Charges V4.225 Data Sources (Outpatient and Professional), 01/01/2022
- Reasonable Charges V4.22 Data Sources (Inpatient)
- 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)
VA Medical Facility Locations
- 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
- Cost-Based and Interagency Federal Register Notice, 10/01/21 | (Web)
- 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 2022 can be viewed at Average Administrative Cost for Prescriptions.
