Reasonable Charges for Medical Care or Services; 2005 Calendar Year Update, 18466-18918 [05-6754]
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18466
Federal Register / Vol. 70, No. 68 / Monday, April 11, 2005 / Notices
DEPARTMENT OF VETERANS
AFFAIRS
Reasonable Charges for Medical Care
or Services; 2005 Calendar Year
Update
Department of Veterans Affairs.
Notice.
AGENCY:
ACTION:
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
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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 https://
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 11, 2005.
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).
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 15,
2004 (69 FR 75111). Skilled nursing
facility/sub-acute inpatient facility
charges remain the same as set forth in
a notice published in the Federal
Register on December 15, 2004 (69 FR
75111).
Based on the methodologies set forth
in 38 CFR 17.101, this document
provides an update to charges for 2005
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
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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 11, 2005.
In this update, we are retaining the
table designations used in the notice
published in the Federal Register on
April 15, 2004 (69 FR 20118).
Accordingly, the tables identified as
being updated by this notice correspond
to the applicable tables published in the
notice, beginning with Table C.
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 April 15, 2004, we set
forth the list of VA medical facility
locations, which includes their threedigit Zip Codes and provider based/nonprovider 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. The
updated data tables and supplementary
tables containing the changes described
will be effective until changed by a
subsequent Federal Register notice.
Approved: February 14, 2005.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
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BILLING CODE 8320–01–C
Agencies
[Federal Register Volume 70, Number 68 (Monday, April 11, 2005)]
[Notices]
[Pages 18466-18918]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-6754]
[[Page 18465]]
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Part II
Department of Veterans Affairs
-----------------------------------------------------------------------
Reasonable Charges for Medical Care or Services; 2005 Calendar Year
Update; Notice
Federal Register / Vol. 70, No. 68 / Monday, April 11, 2005 /
Notices
[[Page 18466]]
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DEPARTMENT OF VETERANS AFFAIRS
Reasonable Charges for Medical Care or Services; 2005 Calendar
Year Update
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
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 https://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 11, 2005.
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).
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 15, 2004 (69
FR 75111). Skilled nursing facility/sub-acute inpatient facility
charges remain the same as set forth in a notice published in the
Federal Register on December 15, 2004 (69 FR 75111).
Based on the methodologies set forth in 38 CFR 17.101, this
document provides an update to charges for 2005 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 11, 2005.
In this update, we are retaining the table designations used in the
notice published in the Federal Register on April 15, 2004 (69 FR
20118). Accordingly, the tables identified as being updated by this
notice correspond to the applicable tables published in the notice,
beginning with Table C.
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 April 15, 2004, 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. The updated data tables and supplementary tables
containing the changes described will be effective until changed by a
subsequent Federal Register notice.
Approved: February 14, 2005.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
BILLING CODE 8320-01-P
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[FR Doc. 05-6754 Filed 4-8-05; 8:45 am]
BILLING CODE 8320-01-C