On Jan. 1, 2021, the U.S. Department of Veterans Affairs (VA) began phasing in a new approach for its community care fee schedule payment rate calculations that better aligns the VA to industry best practices.
Instead of rates being calculated based on the location of the referring VA medical center, rates will now be calculated based on the location of where the care is provided (i.e. rendering locality). This means that beginning Jan. 1, 2021, payment rates under the VA fee schedule may be different from 2020.
Impact of rate changes on providers
The VA generally reimburses hospital care, medical services and extended services at the applicable Medicare rate published by CMS. When no CMS rate is available, the VA and third party administrators reimburse at the lesser amount of billed charges or the VA fee schedule rate. The VA fee schedule rate is the amount published for the designated date of service time period.
The rate changes only apply to services being reimbursed under the VA fee schedule, which is mainly used for geriatrics and extended care services, along with a small number of health care services not covered by the CMS schedule.
With the 2021 VA fee schedule rates based on where the care is provided, community providers can expect better consistency with industry standard practices and alignment with the CMS schedule. In addition, please note the following:
- VA Fee schedule rates for 2021 are calculated to limit decreases in provider reimbursement as much as possible. However, the VA could not eliminate every instance of a rate decrease.
- Rates for home care services were increased to cover the average cost of personal protective equipment per visit, in accordance with the CARES Act.
- The VA’s dental schedule is not publicly available due to the terms of the VA’s contract for compiling a dental services fee schedule.
- Reimbursement rates are subject to change annually and more often if required.
- Alaska VA fee schedule and methodology is an exception and will be released at a later date.
Click here to access the 2021 VA fee schedule and the updated VA fee schedule webpage.
How to look up your fee schedule
To look up which fee schedule you will be reimbursed on, follow these step-by-step instructions:
- Click here to view CMS’ fee schedules and general information.
- Scroll down to view downloads, and click on Zip Code to Carrier Locality File – Revised 11/13/2020 (ZIP) to open the Excel worksheet.
- Find the zip code for where the services were provided, such as the VA location, and note what locality number comes up.
- Then, click here to view the locality key look for your state in the third column and your locality number in the second column. It will then tell you which fee schedule you will be reimbursed on in the fourth column.
For questions, contact VA customer service at 877-881-7618.