[Federal Register Volume 76, Number 238 (Monday, December 12, 2011)]
[Notices]
[Pages 77327-77328]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-31769]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; V3.9, 2012 
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 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 Internet Web

[[Page 77328]]

sites. These changes are effective January 1, 2012.

FOR FURTHER INFORMATION CONTACT: Romona Greene, Chief Business Office 
(10NB1A), 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 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. 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 provides that the actual charge amounts at 
individual VA facilities based on these methodologies and the data 
sources used for calculating those actual charge amounts 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. Certain charges are hereby updated as described below, 
effective January 1, 2012.
    Based on the methodologies set forth in 38 CFR 17.101, this 
document provides an update to charges for 2012 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, 2012. As of the date of this 
notice, the actual charge amounts at individual VA facilities based on 
the methodologies in the regulation will be posted at http://www1.va.gov/CBO/apps/rates/index.asp, under the heading ``Reasonable 
Charges Data Tables'' and identified as ``V3.9 Data Tables (Outpatient 
and Professional).''
    The list of data sources used for calculating the actual charge 
amounts listed above also will be posted at http://www1.va.gov/CBO/apps/rate/index.asp under the heading ``Reasonable Charges Data 
Sources'' and identified as ``Reasonable Charges V3.9 Data Sources 
(Outpatient and Professional)(PDF).''
    Acute inpatient facility charges and skilled nursing facility/sub-
acute inpatient facility charges remain the same as set forth in the 
notice published in the Federal Register on September 28, 2011 (76 FR 
60136). The effective date of those charges is October 1, 2011. The 
data tables containing those actual charges are posted at http://www1.va.gov/CBO/apps/rates/index.asp, under the heading ``Reasonable 
Charges Data Tables'' and identified as ``V3.8 Data Tables 
(Inpatient).'' The data sources used to calculate these charges are 
posted at http://www1.va.gov/CBO/apps/rate/index.asp under the heading 
``Reasonable Charges Data Sources'' and identified as ``Reasonable 
Charges V3.8 Data Sources (Inpatient) (PDF).''
    The list of VA medical facility locations has also been updated. 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. The updated VA medical facility locations will be 
posted on the Internet site of the Veterans Health Administration Chief 
Business Office, currently at http://www1.va.gov/CBO/apps/rate/index.asp under the heading ``VA Medical Facility Locations,'' and 
identified as ``VA Medical Facility Locations V3.9 (Jan12).''
    Consistent with the regulations, the updated data tables and 
supplementary tables containing the changes described in this notice 
will be posted online, as indicated above. The updated data tables and 
supplementary tables containing the changes described will be effective 
until changed by a subsequent Federal Register notice.

    Approved: December 6, 2011.
John R. Gingrich,
Chief of Staff, Department of Veterans Affairs.
[FR Doc. 2011-31769 Filed 12-9-11; 8:45 am]
BILLING CODE 8320-01-P