[Federal Register Volume 73, Number 239 (Thursday, December 11, 2008)]
[Notices]
[Page 75495]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-29390]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; 2009 Calendar 
Year Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: Title 38 of the Code of Federal Regulations (CFR), Sec.  
17.101 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 non-
service-connected disability for which the veteran is entitled to care 
or the payment of expenses for care under a health plan contract; (2) 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 (3) a non-service-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 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. The regulations also provide 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 in the SUPPLEMENTARY INFORMATION Section of this 
notice. These changes are effective January 1, 2009.
    In circumstances 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 or regulations, the method for 
determining VA's charges is set forth at 38 CFR 17.101(a)(8).

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: 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 October 1, 2008 (73 FR 
57219). 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 October 1, 2008 (73 FR 57219).
    Based on the methodologies set forth in 38 CFR 17.101, this 
document provides an update to charges for 2009 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, 2009.
    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 
December 26, 2007 and the notice can also be found in the Federal 
Register (72 FR 73063). 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 data sources used to establish 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 the 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 (Rates).'' The updated data tables and 
supplementary tables containing the changes described will be effective 
until changed by a subsequent Federal Register notice.

    Approved: December 4, 2008.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
 [FR Doc. E8-29390 Filed 12-10-08; 8:45 am]
BILLING CODE 8320-01-P