Community Care

• Facility: The service is performed in a facility setting (i.e., hospital, ambulatory or surgical center)
• Facility type: A hospital or other institution where outpatient and inpatient services are performed
• Locality Description: Name of locality place of service (e.g., city, county)
• Medicare Carrier: The identification number assigned by CMS to a carrier (Medicare Administrative Contractor) authorized to process claims from a physician or supplier
• Medicare Locality: The identification number assigned by CMS to a locality used to identify where care is rendered
• Non-Facility: The service is performed in a non-facility setting (i.e., physician’s office or outpatient clinic)
• Procedure: Current Procedural Terminology/ Healthcare Common Procedure Coding System Industry standard codes used to identify specific surgical, medical, or diagnostic intervention
• Procedure Code Modifier: Supplemental information or adjust care descriptions to provide extra detail concerning a procedure or service
• Rate: Reimbursement amount based on where care is rendered

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

Community Care Network (CCN) 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 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 terms of your contract for information related to schedule usage.

2023 Alaska Professional Fee Schedule

2023 Alaska VA Fee Schedule (Effective for services on or after Feb. 1, 2023)

VA has adjusted the yearly fee schedule update cycle to ensure rate settings take into account comprehensive data from other sources. Beginning 2023, the VA Fee Schedule cycle will run Feb. 1 to Jan. 31. To accommodate the adjustment, the CY22 VA Fee Schedule–All Payers will run through Jan. 31, 2023 service dates.

2023 VA Fee Schedule (Effective for services on and after Feb. 1, 2023)

Which rate applies to me?

1. Open the 2023 VA 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.

VA Community Nursing Home (CNH) Fee Schedule follows the Prospective Payment System (PPS) billing requirements found in Medicare Claims Processing Manual, Chapter 6–Skilled Nursing Facility (SNF) Inpatient Part A Billing and SNF Consolidated Billing with some exceptions.

Medicare Claims Processing Manual, Chapter 6

Exceptions:

1. VA will use the Patient Driven Payment Model-based (PDPM) pricing software using the following specifications:
   1. CNH day 1-100: multiply physical therapy (PT), occupational therapy (OT), speech language pathology (SLP), nursing, and non-case-mix components by 0.6 in addition to any other adjustment factors.
   2. CNH day 101+: remove PT, OT, and SLP components (or set adjustment factor to 0). Multiply nursing and non-case-mix components by 0.9.
   3. The non-therapy ancillary component will follow PDPM (3.0 for the first three days and 1.0 for all remaining days).
2. No special service pricing exists outside of VA PDPM-based PPS for services such as bed hold, memory care, behavioral, HIV/AIDS, respite, ventilator, tracheostomy, and isolation/private room.
3. VA covers some services under CNH authorizations that are not considered part of the nursing home PPS, listed below. Nursing homes are required to submit separate claims for these services.
   
   1. Physician Services: Providers delivering federally mandated or separately authorized services shall bill fee-for-service. The services will be reimbursed at the lesser of billed charges or the Medicare Physician Fee Schedule.
   2. PT, OT and SLP: When PT, OT or SLP therapy is required during days 101+ of a Veteran’s stay, providers must get prior authorization from VA. When care is delivered on days 101+ of a Veteran’s stay, providers will bill fee-for-service using the following procedure codes: G0151, G0152, G0153, G0157, G0158, G0159, G0160, G0161. The services will be reimbursed at the lesser of billed charges or the VA Fee Schedule.
   3. Escort services: When an escort to a medical appointment is indicated, providers must get prior authorization from VA. Providers will bill fee-for-service using the following procedure code: G0156. The services paid will be the lesser of billed charges or the VA Fee Schedule.

2022 Fee Schedules

• CY22 VA Fee Schedule–All Payers (For services from Jan. 1, 2022 through Jan. 31, 2023)
• 2022 Alaska Professional Fee Schedule
• Alaska – Maximum Allowable Charge (MAC), Effective 01/01/2022

2021 Fee Schedules

• CY21 VA Fee Schedule–All Payers
• CCN R5 Alaska Professional Fee Schedule (01/01/21-05/31/2021)
• CCN R5 Alaska Professional Fee Schedule (06/01/2021-12/31/2021)
• Non-CCN R5, Veterans Care Agreement Alaska Professional Fee Schedule (01/01/21-12/31/2021)
• Alaska Maximum Allowable Charge List (01/01/21-12/31/2021)
• Alaska Professional Fee Schedule (01/01/2021-12/31/2021)

2020 Fee Schedules

• CY20 Geriatric and Extended Care (GEC) Fee Schedule
• CY20 VA Fee Schedule (non-GEC)