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VA Fee Schedule

The Department of Veterans Affairs (VA) reimburses hospital care, medical services and extended care services up to the maximum allowable rate. The maximum allowable rate is generally the applicable Medicare rate published by the Centers for Medicare and Medicaid Services (CMS). When there is no Medicare rate available, VA reimburses the lesser of the VA Fee Schedule or billed charges. For the Community Care Network (CCN), when there is no Medicare rate available, the VA Fee Schedule dictates the maximum allowable rate where applicable. In the event neither a CMS nor VA Fee Schedule rate is available, Third Party Administrators (TPA) reimburse a percentage of billed charges.

Please Note:

  • Alaska providers: Please refer to information in the Alaska Providers section for specifics related to care rendered in the state of Alaska.
  • Dental reimbursement rates under CCN are negotiated between the TPA and dental provider, are proprietary, and are not publicly available.
  • Reimbursement rates are subject to change annually and more often if required. Check this page regularly to find the latest rates, and sign up for our VA Provider Advisor newsletter to be informed of rate updates.

    Sign up for the Provider Advisor newsletter
VA Fee Schedule Data Definitions
  • 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
Alaska Providers

Certain services provided to Veterans in the community 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 the 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 appropriate section below based on how care has been referred to you.

2022 Alaska Professional Fee Schedule

2022 Fee Schedule

CY22 VA Fee Schedule–All Payers

Which rate applies to me?

  1. Open the 2022 VA Fee Schedule–All Payers 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.
Community Nursing Home (CNH) Fee Schedule

The 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.
Historical Fee Schedules

Frequently Asked Questions

How do I determine which rate applies to me?

Dates of service January 1, 2022 and after:

  • Open the VA Fee Schedule–All Payers file above.
  • Identify the Medicare locality and carrier for the location where services were rendered.
  • Identify if the services were rendered in a facility or non-facility setting.

Dates of service prior to January 1, 2022:

  • For Geriatric and Extended Care (GEC) services, open the GEC Fee Schedule file above.
    • For non-GEC services, open the VA Fee Schedule (non-GEC) file above for the appropriate year based on when services were rendered.
  • Identify the VA facility that issued the referral.
Which services are included in this fee schedule?

Physician care, hospital care, clinical laboratory, ambulance, and drug services.

How often does VA publish an updated fee schedule?

VA publishes fee schedules annually and may publish additional updates as appropriate. To get the latest updates on VA community care and the latest fee schedule rates, please sign up for VA Provider Advisor newsletter.

Sign up for the Provider Advisor newsletter

How do I download the fee schedule files?

Click on the VA Fee Schedule–All Payers link above and select ‘Save As.’

Contact Us

TriWest Customer Service: 877-266-8749

Optum Customer Service:
CCN Region 1: 888-901-7407
CCN Region 2: 844-839-6108
CCN Region 3: 888-901-6613

VA Customer Service: 877-881-7618

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