[Federal Register Volume 69, Number 73 (Thursday, April 15, 2004)]
[Notices]
[Pages 20118-20521]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-7913]



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Part II





Department of Veterans Affairs





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Reasonable Charges for Medical Care or Services; 2004 Calendar Year 
Update; Notice

  Federal Register / Vol. 69, No. 73 / Thursday, April 15, 2004 / 
Notices  

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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; 2004 Calendar 
Year Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: Section 17.101 of Title 38 of the Code of Federal Regulations 
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 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.

    The regulations include methodologies for establishing billed 
amounts for the following types of charges: 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 Healthcare Common Procedure Coding System 
(HCPCS) Level II codes. The regulations also provide that data for 
calculating actual charge amounts at individual VA facilities based on 
these methodologies will either be published in 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.'' Some of these charges are hereby updated as 
described in the SUPPLEMENTARY INFORMATION section of this notice. 
These changes are effective April 15, 2004.
    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 regulations, the method for determining 
VA's charges is set forth at 38 CFR 17.101(a)(8).
    This notice also includes a correction to Table G, Physician and 
Other Professional Services Relative Value Units (RVUS) by CPT/HCPCS 
Code.

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) 254-0361. (This is 
not a toll free number.)

SUPPLEMENTARY INFORMATION: Of the charge types listed in the Summary 
section of this notice, acute inpatient facility charges and skilled 
nursing facility/sub-acute inpatient facility charges are not being 
changed. Acute inpatient facility charges remain the same as set forth 
in a notice published in the Federal Register on December 19, 2003 (68 
FR 70867). Skilled nursing facility/sub-acute inpatient facility 
charges remain the same as set forth in a notice published in the 
Federal Register on October 2, 2003 (68 FR 56892).
    Based on the methodologies set forth in 38 CFR 17.101, this 
document provides an update to charges for 2004 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 April 15, 2004.
    In this update, we are retaining the table designations used in the 
notice published in the Federal Register on October 2, 2003 (68 FR 
56892). Accordingly, the tables identified as being updated by this 
notice correspond to the applicable tables published in the October 2 
notice, beginning with Table C. Table G is not being updated but is 
being republished in this notice to reflect a correction to the data in 
columns titled Facility Practice Expense RVU's and Non-Facility 
Practice Expense RVU's which were inadvertently reversed in the October 
2, 2003 Federal Register Notice.
    We have updated the list of data sources presented in Supplementary 
Table 1 to reflect the updated data sources used to establish the 
updated charges described in this notice.
    As a reminder, in Supplementary Table 3 published in the Federal 
Register dated December 19, 2003, we set forth the list of VA medical 
facility locations, which includes their three-digit Zip Codes and 
provider-based/non-provider-based designations. In accordance 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.
    Consistent with the regulations, the updated data tables and 
supplementary tables containing the changes described are published 
with this notice and will be effective until changed by a subsequent 
Federal Register notice.

    Approved: March 22, 2004.
Anthony J. Principi,
Secretary of Veterans Affairs.
BILLING CODE 8320-01-P

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[FR Doc. 04-7913 Filed 4-14-04; 8:45 am]
BILLING CODE 8320-01-C