[Federal Register Volume 75, Number 247 (Monday, December 27, 2010)]
[Notices]
[Pages 81335-81336]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-32426]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; 2011 Calendar 
Year Update

AGENCY: Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: This Department of Veterans Affairs (VA) notice informs the 
public of updated data for calculating the ``reasonable charges'' 
collected or recovered by VA 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

[[Page 81336]]

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 charge tables and supplemental tables that 
are applicable to this notice can be viewed on the Veterans Health 
Administration Chief Business Office's Intranet and Internet Web sites. 
These changes are effective January 1, 2011.

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: Section 17.101 of title 38, United States 
Code of Federal Regulations (CFR), 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 regulation also provides 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 below. These changes 
are effective January 1, 2011.
    We note that in cases where 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).
    The regulation includes 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. Each type of charge is addressed 
below.
    Acute inpatient facility charges remain the same as set forth in 
the notice published in the Federal Register on September 27, 2010 (75 
FR 59329). 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 September 27, 2010 (75 FR 59329).
    Based on the methodologies set forth in 38 CFR 17.101, this 
document provides an update to charges for 2011 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, 2011.
    In this update, we are retaining the table designations used for 
HCPCS Level II and 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 January 1, 2010, and the notice can be found in the 
Federal Register. 74 FR 68660 (Dec. 28, 2009). 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.
    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 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.'' The updated data tables and supplementary 
tables containing the changes described will be effective until changed 
by a subsequent Federal Register notice.

    Approved: December 20, 2010.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. 2010-32426 Filed 12-23-10; 8:45 am]
BILLING CODE 8320-01-P