[Federal Register Volume 68, Number 244 (Friday, December 19, 2003)]
[Notices]
[Pages 70867-70898]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-31177]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; 2003 Methodology 
Changes

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: In a companion document published as a final rule in this 
issue of the Federal Register, we are amending 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 a nonservice-connected disability for which the veteran is 
entitled to care (or the payment of expenses of care) under a health 
plan contract;
--For 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
--For a nonservice-connected disability incurred as a result of a motor 
vehicle accident in a State that requires automobile accident 
reparations insurance.


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    The final rule includes methodologies for establishing charges for 
VA medical care and services. Information for calculating actual charge 
amounts at individual VA facilities using these methodologies is set 
forth in a notice published in the Federal Register on October 2, 2003 
(68 FR 56892) as a companion document to the proposed rule containing 
such methodologies published in the same issue of the Federal Register. 
These charges, with changes explained below, are effective December 19, 
2003. Accordingly, interested parties may wish to retain the notice 
document of October 2 and this notice document for future reference.
    When 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 of the final rule, then the alternate methods 
for determining VA's charges as set forth in the regulations at 38 CFR 
17.101(a)(8) will apply.

FOR FURTHER INFORMATION CONTACT: Stephanie Mardon, Chief Business 
Office (168), Veterans Health Administration, Department of Veterans 
Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, (202) 254-0362. 
(This is not a toll free number.)

SUPPLEMENTARY INFORMATION: The companion document published as a final 
rule in this issue of the Federal Register includes the methodologies 
for developing acute inpatient facility charges; skilled nursing 
facility/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 HCPCS Level II codes. Information for calculating actual 
charge amounts at individual VA facilities using these methodologies is 
set forth in a notice published in the Federal Register on October 2, 
2003 (68 FR 56892) as a companion document to the proposed rule 
containing such methodologies published in the same issue of the 
Federal Register. The October 2 notice document also provided 
information on the editions of the data sources used to establish the 
charges, where the various data sources could be obtained, and a list 
of VA facilities that linked them to their three-digit ZIP Codes. This 
document makes changes to the October 2 notice document consistent with 
the provisions of the final rule.

Acute Inpatient Facility Charges

    Acute inpatient facility charges by diagnosis related group (DRG) 
are set forth in Table A in the October 2 notice document. Those 
charges were based on 2003 DRGs. Table A in the October 2 notice 
document is being replaced by Table A in this notice, which provides 
updated charges based on 2004 DRGs.

Physician and Other Professional Charges

    Relative value units (RVUs) and other information for physician and 
other professional services are set forth in Table G in the October 2 
notice document. In Table G, the absence of a modifier indicates that 
the code is a global service, the presence of modifier -26 indicates a 
professional component, and the presence of modifier -TC indicates a 
technical component. Upon further review, we have determined that 
several codes presented with -26 and -TC modifiers should instead be 
presented as global services. Table G in this notice lists the changes 
that we are making to Table G in the October 2 notice document.

Charges for Durable Medical Equipment, Drugs, Injectables, and Other 
Medical Services, Items, and Supplies Identified by HCPCS Level II 
Codes

    Charges for durable medical equipment, drugs, injectables, and 
other medical services, items and supplies identified by HCPCS Level II 
Codes are set forth in Table K in the October 2 notice document. Table 
K contained 28 HCPCS Codes for which we listed the code but did not 
provide a charge. We are changing Table K to delete those codes that 
have no charge.
    Table K in the October 2 notice document included 71 HCPCS codes 
for which we listed four versions of each code: new (modifier NU), 
rental (modifier RR), used (modifier UE), and global (no modifier). We 
are changing Table K to delete the non-modified versions of these codes 
and their associated charges.
    Table K in the October 2 notice document included 21 HCPCS codes 
that included only new (modifier NU) and global (no modifier) versions. 
We are changing Table K to delete the NU-modified versions of these 
codes and their associated charges.
    Table K in the October 2 notice document included 8 HCPCS codes 
associated with facial prostheses that included new impression 
(modifier KM), previous impression (modifier KN), and non-modified 
versions. We are changing Table K to delete the non-modified versions 
of these codes and their associated charges.
    Table K in the October 2 notice document contained five ambiguous 
HCPCS code-modifier pairs that were presented with a rental (RR) 
modifier and also with no modifier. For these five codes (E0749, E0784, 
E1510, K0012, and K0195), we have assigned the non-modified version to 
be new, and have appended the NU modifier accordingly.
    Table K in the October 2 notice document included only one entry 
for HCPCS code E0780, modified with NU. For purposes of clarity, we 
have changed this code to be non-modified.
    Table K in the October 2 notice document included two charges for 
HCPCS code B9002, one for a new item (modifier NU) and one for rental 
of this equipment (modifier RR). We inadvertently omitted the charge 
for B9002-UE, for used equipment, and are now adding that code-modifier 
combination and its associated charge.
    Table K in this notice lists the codes that we are adding, 
changing, and deleting versus Table K in the October 2 notice document.

Data Sources

    The editions of the data sources used to establish the charges are 
set forth in Supplementary Table 1 in the October 2 notice document. We 
used updated data sources to establish the updated acute inpatient 
facility charges set forth in Table A in this notice. Accordingly, 
Supplementary Table 1 in this notice lists the updated data sources 
that we used to update our acute inpatient facility charges.

List of VA Medical Facility Locations

    In Supplementary Table 3 in the October 2 notice document, we set 
forth the list of VA medical facility locations and their three-digit 
ZIP Codes. One of the provisions of the final rule is to designate each 
VA facility as either provider-based or non-provider-based. 
Accordingly, Supplementary Table 3 in the October 2 notice document is 
being replaced by Supplementary Table 3 in this notice, which is 
updated to add the current provider-based/non-provider-based 
designation of each VA facility, and to make additions, changes, and 
deletions to the list of VA facilities. Consistent with the final rule, 
subsequent updates to Supplementary Table 3 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.''


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    Approved: December 10, 2003.
Anthony J. Principi,
Secretary of Veterans Affairs.
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[FR Doc. 03-31177 Filed 12-18-03; 8:45 am]
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