[Federal Register Volume 74, Number 247 (Monday, December 28, 2009)]
[Notices]
[Page 68660]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-30641]
[[Page 68660]]
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DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Medical Care or Services; 2010 Calendar
Year Update
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
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SUMMARY: This Department of Veterans Affairs (VA) notice informs the
public of updated data for calculating the ``reasonable charges''
collected or recovered by VA for medical care or services provided or
furnished by VA to a veteran for: (1) A nonservice-connected disability
for which the veteran is entitled to care or the payment of expenses
for care under a health plan contract; (2) a nonservice-connected
disability incurred incident to the veteran's employment and covered
under a worker's compensation law or plan that provides reimbursement
or indemnification for such care and services; or (3) a nonservice-
connected disability incurred as a result of a motor vehicle accident
in a State that requires automobile accident reparations insurance. The
charge tables and supplemental tables that are applicable to this
notice can be viewed on the Veterans Health Administration Chief
Business Office's Intranet and Internet Web sites. These changes are
effective January 1, 2010.
FOR FURTHER INFORMATION CONTACT: Romona Greene, Chief Business Office
(168), Veterans Health Administration, Department of Veterans Affairs,
810 Vermont Avenue, NW., Washington, DC 20420, (202) 461-1595. This is
not a toll free number.
SUPPLEMENTARY INFORMATION: Section 17.101 of title 38, U.S. Code of
Federal Regulations (CFR), sets forth the Department of Veterans
Affairs (VA) medical regulations concerning ``reasonable charges'' for
medical care or services provided or furnished by VA to a veteran for:
(1) A nonservice-connected disability for which the veteran is entitled
to care (or the payment of expenses for care) under a health plan
contract; (2) a nonservice-connected disability incurred incident to
the veteran's employment and covered under a worker's compensation law
or plan that provides reimbursement or indemnification for such care
and services; or (3) a nonservice-connected disability incurred as a
result of a motor vehicle accident in a State that requires automobile
accident reparations insurance.
The regulation also provides that data for calculating actual
charge amounts at individual VA facilities based on these methodologies
will either be published as a notice in the Federal Register or will be
posted on the Internet site of the Veterans Health Administration Chief
Business Office, currently at http://www.va.gov/cbo, under ``Charge
Data.'' The charge tables and supplemental tables that are applicable
to this Federal Register notice can be viewed on the Veterans Health
Administration Chief Business Office's Intranet and Internet Web sites.
Certain charges are hereby updated as described below. These changes
are effective January 1, 2010.
We note that in cases where charges for medical care or services
provided or furnished at VA expense (by either VA or non-VA providers)
have not been established under other provisions or regulations, the
method for determining VA's charges is set forth at 38 CFR
17.101(a)(8).
The regulation includes methodologies for establishing billed
amounts for the following types of charges: Acute inpatient facility
charges; skilled nursing facility and sub-acute inpatient facility
charges; partial hospitalization facility charges; outpatient facility
charges; physician and other professional charges, including
professional charges for anesthesia services and dental services;
pathology and laboratory charges; observation care facility charges;
ambulance and other emergency transportation charges; and charges for
durable medical equipment, drugs, injectables, and other medical
services, items, and supplies identified by Healthcare Common Procedure
Coding System (HCPCS) Level II codes. Each type of charge is addressed
below.
Acute inpatient facility charges remain the same as set forth in
the notice published in the Federal Register on September 17, 2009 (74
FR 47856). VA's current inpatient charge structure utilizes the
methodology set forth in 38 CFR 17.101 and does not itemize inpatient
bills.
Skilled nursing facility/sub-acute inpatient facility charges also
remain the same as set forth in a notice published in the Federal
Register on September 17, 2009 (74 FR 47856).
Based on the methodologies set forth in 38 CFR 17.101, this
document provides an update to charges for 2010 HCPCS Level II and
Current Procedural Technology (CPT) codes. Charges are also being
updated based on more recent versions of data sources for the following
charge types: Partial hospitalization facility charges; outpatient
facility charges; physician and other professional charges, including
professional charges for anesthesia services and dental services;
pathology and laboratory charges; observation care facility charges;
ambulance and other emergency transportation charges; and charges for
durable medical equipment, drugs, injectables, and other medical
services, items, and supplies identified by HCPCS Level II codes. These
updated charges are effective January 1, 2010.
In this update, we are retaining the table designations used for
HCPCS Level II and Current Procedural Technology (CPT) Codes in the
notice posted on the Internet site of the Veterans Health
Administration Chief Business Office currently at http://www.va.gov/cbo, under ``Charge Data.'' The effective date of this change was
January 1, 2009, and the notice can be found in the Federal Register.
73 FR 75495 (Dec. 11, 2008). Accordingly, the tables identified as
being updated by this notice correspond to the applicable tables posted
on the Internet with the notice, beginning with Table C.
VA has updated the list of data sources presented in Supplementary
Table 1 to reflect the updated charges described in this notice.
The list of VA medical facility locations has also been updated. As
a reminder, in Supplementary Table 3 we set forth the list of VA
medical facility locations, which includes the first three digits of
their zip codes and provider based/non-provider based designations.
Consistent with VA's regulations, the updated data tables and
supplementary tables containing the changes described in this notice
will be posted on the Internet site of the Veterans Health
Administration Chief Business Office, currently at http://www.va.gov/cbo, under ``Charge Data.'' The updated data tables and supplementary
tables containing the changes described will be effective until changed
by a subsequent Federal Register notice.
Approved: December 18, 2009.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. E9-30641 Filed 12-24-09; 8:45 am]
BILLING CODE 8320-01-P