Federal Register / Vol. 85, No. 247 / Wednesday, December 23, 2020 / Notices 84127 

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. 

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 

§ 1729 of title 38 U.S.C., for medical 

care or services provided or furnished 

by VA to a Veteran for: a nonserviceconnected disability for which the 

Veteran is entitled to care (or the 

payment of expenses for care) under a 

health plan contract; a nonserviceconnected 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 § 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 § 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 § 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 


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