[Federal Register Volume 64, Number 80 (Tuesday, April 27, 1999)] [Notices] [Pages 22684-22716] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 99-10374] Federal Register / Vol. 64, No. 80 / Tuesday, April 27, 1999 / Notices [[Page 22684]] DEPARTMENT OF VETERANS AFFAIRS Medical Care Collection or Recovery AGENCY: Department of Veterans Affairs. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: In a companion document published in the ``Rules and Regulations'' section of this issue of the Federal Register, we amended VA's medical regulations concerning collection or recovery by VA for medical care or services provided or furnished to a veteran: --For a non-service connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health- plan contract; --For a non-service 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 --For a non-service connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. The final rule includes methodology for establishing charges for VA medical care or services. Using this methodology, information for calculating actual charge amounts at individual VA facilities for inpatient facility charges, skilled nursing facility/sub-acute inpatient facility charges, outpatient facility charges, and physician charges are set forth in a notice document that was published in the Federal Register on October 13, 1998 (63 FR 54766). These charges, with changes explained below, are effective for the period from September 1, 1999, through December 31, 1999. Accordingly, interested parties may wish to retain the notice document of October 13, 1998, and this notice document for future reference. FOR FURTHER INFORMATION CONTACT: David Cleaver, VHA Office of Finance (174), Veterans Health Administration, Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420, (202) 273-8210. (This is not a toll free number.) SUPPLEMENTARY INFORMATION: The companion document published in the ``Rules and Regulations'' section of this issue of the Federal Register includes the methodology for inpatient facility charges at Sec. 17.101(b), the methodology for skilled nursing facility/sub-acute inpatient facility charges at Sec. 17.101(c), the methodology for outpatient facility charges at Sec. 17.101(d), and the methodology for physician charges at Sec. 17.101(e). Using this methodology, information for calculating actual charge amounts at individual VA facilities for inpatient facility charges, skilled nursing facility/ sub-acute inpatient facility charges, outpatient facility charges, and physician charges are set forth in a notice document that was published in the Federal Register on October 13, 1998 (63 FR 54766). This document makes changes to the October 13 notice document consistent with the methodology of the final rule. Inpatient Facility Charges--DRGs Inpatient facility charges by DRG are set forth in Table A of the notice document published in the Federal Register on October 13, 1998. It is necessary to make changes to a number of DRGs. For five DRGs, 104 through 108, the criteria for assigning inpatient cases to the DRGs have changed, resulting in changes to their charges. One DRG, 109, that had not been used for several years is now being used and has new case assignment criteria. Six DRGs, 456 through 460, and 472, are no longer being used. Eight new DRGs, 504 through 511, have been established. Accordingly, ``Table A.--Inpatient Facility Nationwide Per Diem Charges; By DRG (Diagnosis Related Group)'' in the notice document of October 13, 1998, is changed for the specified DRGs as indicated in the ``Changes To Tables'' section at the end of this document. Inpatient Facility Charges and Skilled Nursing Facility/Sub-acute Inpatient Facility Charges--Geographic Area Adjustment Factors In ``Table B.--Inpatient Facility and Skilled Nursing Facility/Sub- acute Inpatient Facility Geographic Area Adjustment Factors; By VA Facility,'' in the notice document of October 13, 1998, we inadvertently omitted White City, Oregon. Accordingly, the appropriate information for this facility is added to Table B as indicated in the ``Changes To Tables'' section at the end of this document. Outpatient Facility Charges and Physician Charges Information by CPT procedure code used for calculating outpatient facility charges and physician charges was set forth in the notice document in the October 13, 1998, Federal Register in four tables: ``Table C.--Outpatient Facility Nationwide Charges, By CPT (Current Procedural Terminology) Code;'' ``Table E.--Physician Nationwide RVUs (Relative Value Units) and Conversion Factors for CPT Codes With Work Expense and Practice Expense RVUs;'' ``Table F.--Physician Nationwide Charges for Anesthesia and Pathology CPT Codes;'' and ``Table G.-- Physician Nationwide RVUs (Relative Value Units) and Conversion Factors for CPT Codes With Total RVUs Only.'' We have made changes to these tables consisting of a total of 390 entries for 283 different CPT procedure codes, as follows. Under the provisions of Sec. 17.101(d) of the final rule, outpatient services provided by VA that are not customarily performed in an independent clinician's office are subject to outpatient facility charges and separate physician charges. Upon further review we have determined that 46 outpatient procedures for which we originally provided outpatient facility charges in the October 13 Federal Register notice document are customarily performed in an independent clinician's office. Therefore, it is necessary to remove these CPT procedure codes from Table C. As a result of these changes, the non-facility practice expense RVUs for these CPT procedure codes are substituted for the facility practice expense RVUs in Table E. Although the physician charge for these CPT procedure codes will increase, the total charge (without the outpatient facility charge) will decrease. Accordingly, we have removed these 46 CPT procedure codes from Table C and revised their practice expense RVUs in Table E as indicated in the ``Changes To Tables'' section at the end of this document. Also, we determined that for three additional CPT procedure codes (66030, 67710, and 68810), we correctly provided no outpatient facility charges in the notice document in the October 13 Federal Register, but we incorrectly used the facility practice expense RVUs for calculating their physician charges. Therefore, for these CPT procedure codes, we have replaced the facility practice expense RVUs in Table E with the non-facility practice expense RVUs, as indicated in the ``Changes To Tables'' section at the end of this document. As a result of these changes, the physician charges for these three CPT procedure codes will increase. When chemotherapy is provided on an outpatient basis, the physician charge is made using one of 18 CPT procedure codes, 96400 through 96545, listed in Tables E and G of our notice document in the October 13 Federal Register. Two of these CPT procedure codes, 96445 and 96450, were included in the outpatient facility charges in Table C in the October 13 notice document. Outpatient facility charges for the other 16 chemotherapy CPT [[Page 22685]] procedure codes were inadvertently omitted from Table C. Therefore, outpatient facility charges for these 16 CPT procedure codes are added to Table C, as indicated in the ``Changes To Tables'' section at the end of this document. In calculating outpatient facility charges for the 16 chemotherapy CPT procedure codes discussed above, these codes were added to the outpatient facility CPT procedure code group ``Medicine--Global--Not Otherwise Classified'' (Sec. 17.101(d)(3)(i)(DD) of the final rule). With the addition of these CPT procedure codes, the charge factors for this group were recalculated (Sec. 17.101(d)(3) of the final rule), resulting in revised charges for the other 18 CPT procedure codes in the group. For 15 of these CPT procedure codes, the revised charges are lower than those set forth in the notice document in the October 13 Federal Register. For the other three CPT procedure codes, the revised charges are higher. For all 18 of these CPT procedure codes, the outpatient facility charges previously set forth have been replaced in Table C with the revised charges, as indicated in the ``Changes To Tables'' section at the end of this document. The information on outpatient facility charges and physician charges set forth in the notice document in the October 13 Federal Register was based on CPT procedure codes for 1998. Changes to this information are required as a result of changes that have been made to CPT procedure codes for 1999. For outpatient facility charges, these changes consist of adding 27 CPT procedure codes, deleting 13 codes, and revising the charges for 13 codes. For physician charges, these changes consist of adding 117 CPT procedure codes, deleting 63 codes, and revising the charges for 15 codes. These changes are made to Tables C, E, F, and G, as indicated in the ``Changes To Tables'' section at the end of this document. Physician Charges--Geographic Area Adjustment Factors The formula for physician charges includes geographic area adjustment factors. Table H provides physician geographic area adjustment factors for RVUs and conversion factors. Table H was printed incorrectly in the October 13 Federal Register notice. Some column headings were incorrect. Also, some columns requiring numbers to three decimal places only contained numbers to two decimal places. Further, some columns requiring numbers to two decimal places only contained numbers to one decimal place. Accordingly, we are printing a corrected Table H in the ``Changes To Tables'' section at the end of this document. Approved: March 29, 1999. Togo D. West, Jr., Secretary of Veterans Affairs. 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