Cost-Based and Inter-Agency Billing Rates for Medical Care or Services Provided by the Department of Veterans Affairs for FY 2020
This document updates the Cost-Based and Inter-Agency billing rates for medical care or services provided by the Department of Veterans Affairs (VA) furnished in certain circums...
This document updates the Cost-Based and Inter-Agency billing rates for medical care or services provided by the Department of Veterans Affairs (VA) furnished in certain circumstances.
DATES:
The rates set forth herein are effective October 1, 2019.
FOR FURTHER INFORMATION CONTACT:
Romona Greene, Office of Community Care, Revenue Operations, Payer Relations and Services, Rates and Charges (10D1C1), Veterans Health Administration (VHA), Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202) 382-2521. (This is not a toll free number.)
SUPPLEMENTARY INFORMATION:
VA's methodology for computing Cost-Based and Inter-Agency rates for medical care or services provided by VA is set forth in 38 Code of Federal Regulations 17.102(h). Two sets of rates are obtained by applying this methodology, Cost-Based and Inter-Agency.
Cost-Based rates apply to medical care and services that are provided by VA under § 17.102(a), (b), (d) and (g), respectively, in the following circumstances:
In error or based on tentative eligibility,
In a medical emergency,
To pensioners of allied nations, and
For research purposes in circumstances under which the medical care appropriation shall be reimbursed from the research appropriation.
Inter-Agency rates apply to medical care and services that are provided by VA under § 17.102(c) and (f), respectively, in the following circumstances when the care or services provided are not covered by any applicable sharing agreement in accordance with § 17.102(e):
To beneficiaries of the Department of Defense or other Federal agencies; and
To military retirees with chronic disability.
The calculations for the Cost-Based and Inter-Agency rates are the same with two exceptions. Inter-Agency rates are all-inclusive and are not broken down into three components (
i.e.,
Physician; Ancillary; and Nursing, Room and Board), and do not include standard fringe benefit costs that cover Government employee retirement, disability costs, and return on fixed assets. When VA pays for medical care or services from a non-VA source under circumstances in which the Cost-Based or Inter-Agency rates would apply if the care or services had been provided by VA, the charge for such care or services will be the actual amount paid by VA for the care or services. Inpatient charges will be at the per diem rates shown for the type of bed section or discrete treatment unit providing the care.
The following table depicts the Cost-Based and Inter-Agency rates that are effective October 1, 2019 and will remain in effect until the next fiscal year
Federal Register
update. These rates supersede those established by the
Federal Register
notice published on August 28, 2018, at 83 FR 43958.
Cost-based rates
Inter-agency rates
A. Hospital Care per inpatient day:
General Medicine:
All Inclusive Rate
$4,301
$4,156
Physician
515
Ancillary
1,121
Nursing Room and Board
2,665
Neurology:
All Inclusive Rate
4,232
4,086
Physician
620
Ancillary
1,117
Nursing Room and Board
2,495
Rehabilitation Medicine:
All Inclusive Rate
2,910
2,803
Physician
331
Ancillary
889
Nursing Room and Board
1,690
Blind Rehabilitation:
All Inclusive Rate
1,995
1,920
Physician
161
Ancillary
991
Nursing Room and Board
843
Spinal Cord Injury:
All Inclusive Rate
2,636
2,540
Physician
327
Ancillary
663
Nursing Room and Board
1,646
Surgery:
All Inclusive Rate
7,526
7,272
Physician
829
Ancillary
2,283
Nursing Room and Board
4,414
General Psychiatry:
All Inclusive Rate
2,174
2,091
Physician
205
( printed page 51729)
Ancillary
342
Nursing Room and Board
1,627
Substance Abuse (Alcohol and Drug Treatment):
All Inclusive Rate
2,232
2,147
Physician
213
Ancillary
516
Nursing Room and Board
1,503
Psychosocial Residential Rehabilitation Program:
All Inclusive Rate
826
797
Physician
52
Ancillary
87
Nursing Room and Board
687
Intermediate Medicine:
All Inclusive Rate
3,301
3,182
Physician
162
Ancillary
484
Nursing Room and Board
2,655
Poly-trauma Inpatient:
All Inclusive Rate
3,223
3,097
Physician
366
Ancillary
985
Nursing Room and Board
1,872
B. Nursing Home Care, Per Day:
All Inclusive Rate
1,361
1,311
Physician
42
Ancillary
184
Nursing Room and Board
1135
C. Outpatient Medical Treatments:
Outpatient Visit (to include Ineligible Emergency Dental Care)
389
376
Outpatient Physical Medicine & Rehabilitation Service Visit
238
228
Outpatient Poly-trauma/Traumatic Brain Injury
671
649
Note:
Outpatient Prescriptions will be billed at Drug Cost plus Administrative Fee.
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. Robert L. Wilkie, Secretary, Department of Veterans Affairs, approved this document on September 26, 2019, for publication.
Dated: September 26, 2019.
Jeffrey M. Martin,
Assistant Director, Office of Regulation Policy & Management, Office of the Secretary, Department of Veterans Affairs.
Use this for formal legal and research references to the published document.
84 FR 51728
Web Citation
Suggested Web Citation
Use this when citing the archival web version of the document.
“Cost-Based and Inter-Agency Billing Rates for Medical Care or Services Provided by the Department of Veterans Affairs for FY 2020,” thefederalregister.org (September 30, 2019), https://thefederalregister.org/documents/2019-21330/cost-based-and-inter-agency-billing-rates-for-medical-care-or-services-provided-by-the-department-of-veterans-affairs-fo.
38 Code of Federal Regulations 17.102(h)