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Veterans Health Administration


VHA Invasive Procedure Complexity for Surgical Programs

The Department of Veterans Affairs (VA), the nation's largest health care system, has processes in place to ensure that invasive procedures are performed under the safest possible conditions at facilities with the resources to support them.

 The Veterans Health Administration (VHA) assigned each of its Surgical Programs an "invasive procedure complexity" level of Inpatient Complex, Inpatient Intermediate, Ambulatory Procedure Center (APC) Advanced, Inpatient Standard, or APC Basic. The policy that governs invasive procedure complexity is Directive 1220(1) Facility Procedure Complexity Designation Requirements to Perform Invasive Procedures In Any Clinical Setting. Learn more about what invasive procedure complexity means.

 A listing of all approved VHA Surgery Programs and their invasive procedure complexity designations is below. The listing below does not include the additional invasive procedure designations for non-surgical facilities.  The list is sorted by state.

Inpatient and Ambulatory VHA surgery programs and their complexity designations
VHA Surgical Program Location Veterans Integrated Service Network (VISN) Operative Complexity Designation
Birmingham, AL 7 Inpatient Complex
Montgomery, AL 7 Inpatient Standard
Fayetteville, AR 16 Inpatient Intermediate
Little Rock, AR 16 Inpatient Complex
Phoenix, AZ 22 Inpatient Complex
Tucson, AZ 22 Inpatient Complex
Fresno, CA 21 Inpatient Intermediate
Martinez, CA 21 APC Advanced
Sacramento, CA 21 Inpatient Complex
Palo Alto, CA 21 Inpatient Complex
San Francisco, CA 21 Inpatient Complex
Loma Linda, CA 22 Inpatient Complex
Long Beach, CA 22 Inpatient Complex
San Diego, CA 22 Inpatient Complex
West Los Angeles, CA 22 Inpatient Complex
Denver, CO 19 Inpatient Complex
Grand Junction, CO 19 Inpatient Standard
West Haven, CT 1 Inpatient Complex
Washington, DC 5 Inpatient Complex
Wilmington, DE 4 Inpatient Intermediate
Bay Pines, FL 8 Inpatient Complex
Cape Coral, FL 8 Ambulatory-Advanced
Gainesville, FL 8 Inpatient Complex
Jacksonville, FL 8 APC Basic
Lake Baldwin, FL 8 APC Basic
Lake City, FL 8 APC Advanced
Miami, FL 8 Inpatient Complex
Orlando, FL 8 Inpatient Intermediate
Pensacola Naval, FL 16 APC Basic
Tampa, FL 8 Inpatient Complex
West Palm Beach, FL 8 Inpatient Intermediate
Augusta, GA 7 Inpatient Complex
Atlanta, GA 7 Inpatient Complex
Dublin, GA 7 Inpatient Standard
Des Moines, IA 23 Inpatient Intermediate
Iowa City, IA 23 Inpatient Complex
Boise, ID 20 Inpatient Intermediate
Danville, IL 12 APC Basic
Chicago-Jesse Brown, IL 12 Inpatient Complex
Hines, IL 12 Inpatient Complex
North Chicago, IL 12 Inpatient Intermediate
Marion, IL 15 Inpatient Standard
Evansville, IN 15 APC Basic
Fort Wayne, IN 10 APC Advanced
Indianapolis, IN 10 Inpatient Complex
Leavenworth, KS 15 Inpatient Standard
Topeka, KS 15 APC Basic
Wichita, KS 15 Inpatient Intermediate
Lexington, KY 9 Inpatient Complex
Louisville, KY 9 Inpatient Complex
New Orleans, LA 16 Inpatient Complex
Pineville, LA 16 APC Advanced
Shreveport, LA 16 Inpatient Complex
Boston-Jamaica Plain, MA 1 APC Advanced
West Roxbury, MA 1 Inpatient Complex
Baltimore, MD 5 Inpatient Complex
Togus, ME 1 Inpatient Intermediate
Ann Arbor, MI 10 Inpatient Complex
Detroit, MI 10 Inpatient Complex
Saginaw, MI 10 APC Basic
Iron Mountain, MI 12 APC Basic
Minneapolis, MN 23 Inpatient Complex
St. Cloud, MN 23 APC Basic
Columbia, MO 15 Inpatient Complex
Kansas City, MO 15 Inpatient Complex
St. Louis, MO 15 Inpatient Complex
Biloxi, MS 16 Inpatient Intermediate
Jackson, MS 16 Inpatient Complex
Billings, MT 19 APC Basic
Fort Harrison, MT 19 Inpatient Standard
Asheville, NC 6 Inpatient Complex
Charlotte, NC 6 APC Basic
Durham, NC 6 Inpatient Complex
Fayetteville, NC 6 Inpatient Standard
Fayetteville-ASC, NC 6 APC Basic
Kernersville, NC 6 APC Advanced
Salisbury, NC 6 Inpatient Intermediate
Fargo, ND 23 Inpatient Intermediate
Omaha, NE 23 Inpatient Complex
Manchester, NH 1 APC Basic
East Orange, NJ 2 Inpatient Complex
Albuquerque, NM 22 Inpatient Complex
Reno, NV 21 Inpatient Intermediate
Las Vegas, NV 21 Inpatient Intermediate
Albany, NY 2 Inpatient Complex
Buffalo, NY 2 Inpatient Complex
Syracuse, NY 2 Inpatient Complex
Bronx, NY 2 Inpatient Complex
Brooklyn, NY 2 Inpatient Complex
Northport, NY 2 Inpatient Complex
New York, NY 2 Inpatient Complex
Cincinnati, OH 10 Inpatient Complex
Cleveland-ASC, OH 10 APC Basic
Cleveland, OH 10 Inpatient Complex
Columbus, OH 10 APC Advanced
Dayton, OH 10 Inpatient Intermediate
Muskogee, OK 19 Inpatient Intermediate
Oklahoma City, OK 19 Inpatient Complex
Eugene, OR 20 APC Advanced
Portland, OR 20 Inpatient Complex
Roseburg, OR 20 APC Basic
Altoona, PA 4 APC Advanced
Erie, PA 4 APC Advanced
Lebanon, PA 4 Inpatient Intermediate
Philadelphia, PA 4 Inpatient Complex
Pittsburgh, PA 4 Inpatient Complex
Wilkes-Barre, PA 4 Inpatient Intermediate
San Juan, PR 8 Inpatient Complex
Providence, RI 1 Inpatient Intermediate
Charleston, SC 7 Inpatient Complex
Columbia, SC 7 Inpatient Complex
Fort Meade, SD 23 Inpatient Standard
Hot Springs, SD 23 APC Basic
Sioux Falls, SD 23 Inpatient Intermediate
Memphis, TN 9 Inpatient Complex
Mountain Home, TN 9 Inpatient Intermediate
Murfreesboro, TN 9 APC Basic
Nashville, TN 9 Inpatient Complex
Houston, TX 16 Inpatient Complex
Dallas, TX 17 Inpatient Complex
Harlingen, TX 17 APC Basic
Lubbock, TX 17 APC Basic
Northwest San Antonio, TX 17 APC Basic
San Antonio, TX 17 Inpatient Complex
Temple, TX 17 Inpatient Complex
Amarillo, TX 17 Inpatient Intermediate
El Paso, TX 17 APC Basic
Salt Lake City, UT 19 Inpatient Complex
Clarksburg, WV 5 Inpatient Intermediate
Hampton, VA 6 Inpatient Intermediate
Richmond, VA 6 Inpatient Complex
Salem, VA 6 Inpatient Intermediate
White River Junction, VT 1 Inpatient Intermediate
Seattle, WA 20 Inpatient Complex
Spokane, WA 20 Inpatient Standard
Tacoma, WA 20 APC Basic
Green Bay, WI 12 APC Basic
Madison, WI 12 Inpatient Complex
Milwaukee, WI 12 Inpatient Complex
Martinsburg, WV 5 Inpatient Intermediate
Beckley, WV 5 Inpatient Standard
Huntington, WV 5 Inpatient Complex
Cheyenne, WY 19 Inpatient Standard

Table Data Updated: 2/5/2024

More Information about VHA Invasive Procedure Complexity

VHA “invasive procedure complexity” establishes the infrastructure that is required at a VHA facility in relationship to the complexity of the procedures being performed. This requirement ensures that the scope of the invasive procedure is within the capability of the facility. This requirement makes sure that invasive procedures are performed under the safest possible conditions. A facility infrastructure refers to: physicians, nursing, other medical personnel, space, equipment, supplies, sterile processing, and other support services related to an invasive procedure. 

 Examples of procedures performed in a VHA Surgery Program at the different types of invasive procedure complexity designations are:

  • Example of an APC Basic procedure is cataract surgery (replacement of the eye lens).
  • Example of an Inpatient Standard procedure is an appendectomy (removal of the appendix).
  • Example of an APC Advanced procedure is a total knee replacement (arthroplasty).
  • Example of an Inpatient Intermediate procedure is a shoulder joint reconstruction.
  • Example of an Inpatient Complex procedure is a coronary artery bypass graft (CABG), a type of open-heart surgery.