Reasonable Charges for Medical Care or Services; 2006 Calendar Year Update, 982-1345 [06-7]

Download as PDF 982 Federal Register / Vol. 71, No. 4 / Friday, January 6, 2006 / Notices DEPARTMENT OF VETERANS AFFAIRS Reasonable Charges for Medical Care or Services; 2006 Calendar Year Update Department of Veterans Affairs. Notice. AGENCY: ACTION: cprice-sewell on PROD1PC62 with NOTICES 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 VerDate Aug<31>2005 15:31 Jan 05, 2006 Jkt 208001 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 January 1, 2006. 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 September 28, 2005 (70 FR 56772). Skilled nursing facility/sub-acute inpatient facility charges remain the same as set forth in a notice published in the Federal Register on September 28, 2005 (70 FR 56772). Based on the methodologies set forth in 38 CFR 17.101, this document provides an update to charges for 2006 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 PO 00000 Frm 00002 Fmt 4701 Sfmt 4703 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, 2006. In this update, we are retaining the table designations used in the notice published in the Federal Register on April 11, 2005 (70 FR 18466). 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 September 28, 2005, 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: December 20, 2005. Gordon H. Mansfield, Deputy Secretary of Veterans Affairs. 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Agencies

DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 71, Number 4 (Friday, January 6, 2006)]
[Notices]
[Pages 982-1345]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-7]



[[Page 981]]

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Part II





Department of Veterans Affairs





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Reasonable Charges for Medical Care or Services; 2006 Calendar Year 
Update; Notice

Federal Register / Vol. 71, No. 4 / Friday, January 6, 2006 / 
Notices

[[Page 982]]


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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; 2006 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 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 January 1, 2006.
    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 September 28, 2005 (70 
FR 56772). Skilled nursing facility/sub-acute inpatient facility 
charges remain the same as set forth in a notice published in the 
Federal Register on September 28, 2005 (70 FR 56772).
    Based on the methodologies set forth in 38 CFR 17.101, this 
document provides an update to charges for 2006 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, 2006.
    In this update, we are retaining the table designations used in the 
notice published in the Federal Register on April 11, 2005 (70 FR 
18466). 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 September 28, 2005, 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: December 20, 2005.
Gordon H. Mansfield,
Deputy Secretary of Veterans Affairs.
BILLING CODE 8320-01-P

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[FR Doc. 06-7 Filed 1-5-06; 8:45 am]
BILLING CODE 8320-01-C

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