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Non-VA emergency medical care

Emergency care of service-connected conditions

The Department of Veterans Affairs (VA) is permitted under Title 38 United State Code (U.S.C.) § 1728 to make payment or reimbursement to a claimant for emergency treatment provided to a Veteran with a VA-adjudicated, service-connected (SC) condition, a nonservice-connected (NSC) disability associated with and held to be aggravating a service-connected condition, or any condition of a Veteran, if total disability is permanent in nature from a service-connected disability, or for a Veteran participating in a Chapter 31 Vocational Rehabilitation program.

There is a timely filing limit for unauthorized inpatient or outpatient medical care claims. Claims must be submitted within two years from the date of care.

Individual eligibility determinations are difficult, and therefore outside the scope of this general information. Please contact your local VA health care facility for individual Veteran eligibility questions or concerns.

A local VA health care facility may request medical documentation to support adjudication of a claim submitted from a community health care provider. In addition, standard billing forms such as the UB-04 CMS-1450 or CMS-1500 are required. For this type of unauthorized emergent care, VA requires claimants to fill out and submit VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services.

Basic authorities and payment methodologies to provide unauthorized medical care are contained in: 38 U.S.C. § 1728 and 38 CFR § 17.120 – § 17.132. (Links to regulatory information are listed below).

Emergency care of nonservice-connected conditions

Title 38 United States Code (U.S.C.) § 1725 (also known as 'Mill Bill') allows the Department of Veterans Affairs (VA) to make payment or reimbursement to a claimant for emergency treatment provided to a Veteran for nonservice-connected conditions in certain circumstances. In such cases, VA must be the payer of last resort.

There is a timely filing limit for unauthorized inpatient or outpatient medical care claims. Claims must be submitted within 90 days from the date of care.

Individual eligibility determinations are difficult, and therefore outside the scope of this general information. Please contact your local VA health care facility for individual Veteran eligibility questions or concerns.

A local VA health care facility may request medical documentation to support adjudication of a claim submitted from a community health care provider. In addition, standard billing forms such as the UB-04 CMS-1450 or CMS-1500 are required. For this type of unauthorized emergent care, VA requires claimants to fill out and submit VA Form 10-583, Claim for Payment of Cost of Unauthorized Medical Services.

Basic authorities and payment methodologies to provide unauthorized medical care for nonservice-connected events are contained in: 38 U.S.C. § 1725 and 38 CFR § 17.1000 – 1008. (Links to regulatory information are listed below).

More information

• Fact Sheet 20-02: Non-VA Emergency Care

• Veterans' Emergency Care Fairness Act

• Basic authorities and payment methodologies to provide unauthorized medical care
  – 38 U.S.C. § 1728, Reimbursement of certain medical expenses
  – 38 CFR § 17.120, Payment/reimbursement of expenses of hospital care...not previously authorized
  – 38 CFR § 17.121, Limitations on payment/reimbursement of emergency hospital care...not previously authorized
  – 38 CFR § 17.122, Payment/reimbursement of expenses of repairs to prosthetic...without prior authorization
  – 38 CFR § 17.123, Claimants
  – 38 CFR § 17.124, Preparation of claims
  – 38 CFR § 17.125, Where to file claims
  – 38 CFR § 17.126, Timely filing
  – 38 CFR § 17.127, Date of filing claims
  – 38 CFR § 17.128, Allowable rates and fees
  – 38 CFR § 17.129, Retroactive payments prohibited
  – 38 CFR § 17.130, Payment for treatment dependent upon preference prohibited
  – 38 CFR § 17.131, Payment of abandoned claims prohibited
  – 38 CFR § 17.132, Appeals

• Basic authorities and payment methodologies to provide unauthorized medical care for nonservice-connected events
  – 38 U.S.C. § 1725, Reimbursement for emergency treatment
  – 38 CFR § 17.1000, Payment/reimbursement for emergency services for nonservice-connected conditions....
  – 38 CFR § 17.1001, Definitions
  – 38 CFR § 17.1002, Substantive conditions for payment or reimbursement
  – 38 CFR § 17.1003, Emergency transportation
  – 38 CFR § 17.1004, Filing claims
  – 38 CFR § 17.1005, Payment limitations
  – 38 CFR § 17.1006, Decisionmakers
  – 38 CFR § 17.1007, Independent right of recovery
  – 38 CFR § 17.1008, Balance billing prohibited