Reasonable Charges for Medical Care or Services; v4.215 Calendar Year (CY) 2021 Update, 84127 [2020-28441]

Agencies

• DEPARTMENT OF VETERANS AFFAIRS

[Federal Register Volume 85, Number 247 (Wednesday, December 23, 2020)]
[Notices]
[Page 84127]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-28441]



[[Page 84127]]

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DEPARTMENT OF VETERANS AFFAIRS


Reasonable Charges for Medical Care or Services; v4.215 Calendar 
Year (CY) 2021 Update

AGENCY: Department of Veterans Affairs (VA).

ACTION: Notice.

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SUMMARY: This VA notice updates the data for calculating what VA refers 
to as the Reasonable Charges collected or recovered by VA for medical 
care or services provided or furnished by VA to a Veteran.

DATES: This change is effective January 1, 2021.

FOR FURTHER INFORMATION CONTACT: Romona Greene, Office of Community 
Care, Revenue Operations, Payer Relations and Services, Rates and 
Charges (13RO1), Veterans Health Administration, Department of Veterans 
Affairs, 810 Vermont Avenue NW, Washington, DC 20420; telephone: 202-
382-2521 (This is not a toll-free number).

SUPPLEMENTARY INFORMATION: Section 17.101(a)(1) of title 38 CFR sets 
forth the Reasonable Charges, relating to collection or recovery by VA, 
under Sec.  1729 of title 38 U.S.C., 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 for care) under a health plan contract; 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. 
Section 17.101 provides the methodologies for establishing billed 
amounts for several types of charges; however, this notice will only 
address 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.
    Section 17.101(a)(2) provides that the actual charge amounts at 
individual VA medical facilities are based on these methodologies and 
the data sources used for calculating those actual charge amounts will 
either be published in a notice in the Federal Register or will be 
posted on VA's Office of Community Care (OCC) website at: https://www.va.gov/communitycare/revenue_ops/payer_rates.asp.
    Certain charges are updated as stated in this notice and will be 
effective on January 1, 2021.
    In cases where VA has not established charges for medical care or 
services provided or furnished at VA expense (by either VA or non-VA 
providers) under other provisions or regulations, the method for 
determining VA's charges is set forth at 38 CFR 17.101(a)(8).
    Based on the methodologies set forth in Sec.  17.101, this notice 
provides an update to charges for CY 2021 HCPCS Level II and Current 
Procedural Terminology 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. As of the date of this 
notice, the actual charge amounts at individual VA medical facilities 
are based on the methodologies and data sources described in Sec.  
17.101. The nationwide charges will be posted on VA's OCC website at: 
https://www.va.gov/communitycare/revenue_ops/payer_rates.asp under the 
heading ``Reasonable Charges Data Tables and identified as v4.215 Data 
Tables (Outpatient and Professional)''.
    The list of data sources used for calculating the actual charge 
amounts listed above also will be posted on VA's OCC website under the 
heading ``Reasonable Charges Data Sources and identified as Reasonable 
Charges v4.215 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 22, 2020 (85 FR 
59606).
    We are also updating the list of VA medical facility locations. The 
list of VA medical facility locations, including the first three digits 
of their zip codes as well as their provider-based designation, will be 
posted on VA's OCC website under the heading ``VA Medical Facility 
Locations and identified as v4.215 (Jan21)''.
    Consistent with Sec.  17.101(a)(2), the updated data and 
supplementary tables containing the changes described in this notice 
will be posted on VA's OCC website at: https://www.va.gov/communitycare/revenue_ops/payer_rates.asp under the heading 
``Reasonable Charges Rules, Notices, and Federal Register and 
identified as v4.215 Federal Register Notice 01/01/21 (Outpatient and 
Professional)''. The updated data and supplementary tables containing 
the changes described will be effective until changed by a subsequent 
Federal Register notice.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. Brooks D. 
Tucker, Assistant Secretary for Congressional and Legislative Affairs, 
Performing the Delegable Duties of the Chief of Staff, Department of 
Veterans Affairs, approved this document on December 18, 2020, for 
publication.

Luvenia Potts,
Regulation Development Coordinator, Office of Regulation Policy & 
Management, Office of the Secretary, Department of Veterans Affairs.
[FR Doc. 2020-28441 Filed 12-22-20; 8:45 am]
BILLING CODE 8320-01-P