[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  

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DEPARTMENT OF VETERANS AFFAIRS


Medical Care Collection or Recovery

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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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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[FR Doc. 99-10374 Filed 4-26-99; 8:45 am]
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