[Federal Register Volume 64, Number 80 (Tuesday, April 27, 1999)]
[Notices]
[Pages 22684-22716]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-10374]
Federal Register / Vol. 64, No. 80 / Tuesday, April 27, 1999 /
Notices
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DEPARTMENT OF VETERANS AFFAIRS
Medical Care Collection or Recovery
AGENCY: Department of Veterans Affairs.
ACTION: Notice.
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SUMMARY: In a companion document published in the ``Rules and
Regulations'' section of this issue of the Federal Register, we amended
VA's medical regulations concerning collection or recovery by VA for
medical care or services provided or furnished to a veteran:
--For a non-service connected disability for which the veteran is
entitled to care (or the payment of expenses of care) under a health-
plan contract;
--For a non-service 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 non-service connected disability incurred as a result of a
motor vehicle accident in a State that requires automobile accident
reparations insurance.
The final rule includes methodology for establishing charges for VA
medical care or services. Using this methodology, information for
calculating actual charge amounts at individual VA facilities for
inpatient facility charges, skilled nursing facility/sub-acute
inpatient facility charges, outpatient facility charges, and physician
charges are set forth in a notice document that was published in the
Federal Register on October 13, 1998 (63 FR 54766). These charges, with
changes explained below, are effective for the period from September 1,
1999, through December 31, 1999. Accordingly, interested parties may
wish to retain the notice document of October 13, 1998, and this notice
document for future reference.
FOR FURTHER INFORMATION CONTACT: David Cleaver, VHA Office of Finance
(174), Veterans Health Administration, Department of Veterans Affairs,
810 Vermont Avenue, NW, Washington, DC 20420, (202) 273-8210. (This is
not a toll free number.)
SUPPLEMENTARY INFORMATION: The companion document published in the
``Rules and Regulations'' section of this issue of the Federal Register
includes the methodology for inpatient facility charges at
Sec. 17.101(b), the methodology for skilled nursing facility/sub-acute
inpatient facility charges at Sec. 17.101(c), the methodology for
outpatient facility charges at Sec. 17.101(d), and the methodology for
physician charges at Sec. 17.101(e). Using this methodology,
information for calculating actual charge amounts at individual VA
facilities for inpatient facility charges, skilled nursing facility/
sub-acute inpatient facility charges, outpatient facility charges, and
physician charges are set forth in a notice document that was published
in the Federal Register on October 13, 1998 (63 FR 54766). This
document makes changes to the October 13 notice document consistent
with the methodology of the final rule.
Inpatient Facility Charges--DRGs
Inpatient facility charges by DRG are set forth in Table A of the
notice document published in the Federal Register on October 13, 1998.
It is necessary to make changes to a number of DRGs. For five DRGs, 104
through 108, the criteria for assigning inpatient cases to the DRGs
have changed, resulting in changes to their charges. One DRG, 109, that
had not been used for several years is now being used and has new case
assignment criteria. Six DRGs, 456 through 460, and 472, are no longer
being used. Eight new DRGs, 504 through 511, have been established.
Accordingly, ``Table A.--Inpatient Facility Nationwide Per Diem
Charges; By DRG (Diagnosis Related Group)'' in the notice document of
October 13, 1998, is changed for the specified DRGs as indicated in the
``Changes To Tables'' section at the end of this document.
Inpatient Facility Charges and Skilled Nursing Facility/Sub-acute
Inpatient Facility Charges--Geographic Area Adjustment Factors
In ``Table B.--Inpatient Facility and Skilled Nursing Facility/Sub-
acute Inpatient Facility Geographic Area Adjustment Factors; By VA
Facility,'' in the notice document of October 13, 1998, we
inadvertently omitted White City, Oregon. Accordingly, the appropriate
information for this facility is added to Table B as indicated in the
``Changes To Tables'' section at the end of this document.
Outpatient Facility Charges and Physician Charges
Information by CPT procedure code used for calculating outpatient
facility charges and physician charges was set forth in the notice
document in the October 13, 1998, Federal Register in four tables:
``Table C.--Outpatient Facility Nationwide Charges, By CPT (Current
Procedural Terminology) Code;'' ``Table E.--Physician Nationwide RVUs
(Relative Value Units) and Conversion Factors for CPT Codes With Work
Expense and Practice Expense RVUs;'' ``Table F.--Physician Nationwide
Charges for Anesthesia and Pathology CPT Codes;'' and ``Table G.--
Physician Nationwide RVUs (Relative Value Units) and Conversion Factors
for CPT Codes With Total RVUs Only.'' We have made changes to these
tables consisting of a total of 390 entries for 283 different CPT
procedure codes, as follows.
Under the provisions of Sec. 17.101(d) of the final rule,
outpatient services provided by VA that are not customarily performed
in an independent clinician's office are subject to outpatient facility
charges and separate physician charges. Upon further review we have
determined that 46 outpatient procedures for which we originally
provided outpatient facility charges in the October 13 Federal Register
notice document are customarily performed in an independent clinician's
office. Therefore, it is necessary to remove these CPT procedure codes
from Table C. As a result of these changes, the non-facility practice
expense RVUs for these CPT procedure codes are substituted for the
facility practice expense RVUs in Table E. Although the physician
charge for these CPT procedure codes will increase, the total charge
(without the outpatient facility charge) will decrease. Accordingly, we
have removed these 46 CPT procedure codes from Table C and revised
their practice expense RVUs in Table E as indicated in the ``Changes To
Tables'' section at the end of this document.
Also, we determined that for three additional CPT procedure codes
(66030, 67710, and 68810), we correctly provided no outpatient facility
charges in the notice document in the October 13 Federal Register, but
we incorrectly used the facility practice expense RVUs for calculating
their physician charges. Therefore, for these CPT procedure codes, we
have replaced the facility practice expense RVUs in Table E with the
non-facility practice expense RVUs, as indicated in the ``Changes To
Tables'' section at the end of this document. As a result of these
changes, the physician charges for these three CPT procedure codes will
increase.
When chemotherapy is provided on an outpatient basis, the physician
charge is made using one of 18 CPT procedure codes, 96400 through
96545, listed in Tables E and G of our notice document in the October
13 Federal Register. Two of these CPT procedure codes, 96445 and 96450,
were included in the outpatient facility charges in Table C in the
October 13 notice document. Outpatient facility charges for the other
16 chemotherapy CPT
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procedure codes were inadvertently omitted from Table C. Therefore,
outpatient facility charges for these 16 CPT procedure codes are added
to Table C, as indicated in the ``Changes To Tables'' section at the
end of this document.
In calculating outpatient facility charges for the 16 chemotherapy
CPT procedure codes discussed above, these codes were added to the
outpatient facility CPT procedure code group ``Medicine--Global--Not
Otherwise Classified'' (Sec. 17.101(d)(3)(i)(DD) of the final rule).
With the addition of these CPT procedure codes, the charge factors for
this group were recalculated (Sec. 17.101(d)(3) of the final rule),
resulting in revised charges for the other 18 CPT procedure codes in
the group. For 15 of these CPT procedure codes, the revised charges are
lower than those set forth in the notice document in the October 13
Federal Register. For the other three CPT procedure codes, the revised
charges are higher. For all 18 of these CPT procedure codes, the
outpatient facility charges previously set forth have been replaced in
Table C with the revised charges, as indicated in the ``Changes To
Tables'' section at the end of this document.
The information on outpatient facility charges and physician
charges set forth in the notice document in the October 13 Federal
Register was based on CPT procedure codes for 1998. Changes to this
information are required as a result of changes that have been made to
CPT procedure codes for 1999. For outpatient facility charges, these
changes consist of adding 27 CPT procedure codes, deleting 13 codes,
and revising the charges for 13 codes. For physician charges, these
changes consist of adding 117 CPT procedure codes, deleting 63 codes,
and revising the charges for 15 codes. These changes are made to Tables
C, E, F, and G, as indicated in the ``Changes To Tables'' section at
the end of this document.
Physician Charges--Geographic Area Adjustment Factors
The formula for physician charges includes geographic area
adjustment factors. Table H provides physician geographic area
adjustment factors for RVUs and conversion factors. Table H was printed
incorrectly in the October 13 Federal Register notice. Some column
headings were incorrect. Also, some columns requiring numbers to three
decimal places only contained numbers to two decimal places. Further,
some columns requiring numbers to two decimal places only contained
numbers to one decimal place. Accordingly, we are printing a corrected
Table H in the ``Changes To Tables'' section at the end of this
document.
Approved: March 29, 1999.
Togo D. West, Jr.,
Secretary of Veterans Affairs.
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[FR Doc. 99-10374 Filed 4-26-99; 8:45 am]
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