Payer Rates and Charges
Reasonable Charges are based on amounts that third parties pay for the same services furnished by private-sector health care providers in the same geographic area. In the past, VA used average cost-based, per diem rates for billing insurers. Reasonable charges are calculated for inpatient and outpatient facility charges, and for professional or clinician charges for inpatient and outpatient care.
- Reasonable Charges 38 CFR 17.100 Provider Based Requirement Final Rule, 10/01/2020
(38 CFR 17.100 Web) - Reasonable Charges V4.21 Federal Register Notice, 10/1/2020 (Inpatient)
(V4.21 FR Web) - Reasonable Charges V3.27 Federal Register Notice, 01/01/20 (Outpatient and Professional)
(V3.27 FR Web) - Reasonable Charges V3.26 Federal Register Notice, 10/01/19 (Inpatient)
(V3.26 FR Web) - Reasonable Charges V3.25 Federal Register Notice, 01/01/19 (Outpatient and Professional)
(V3.25 FR Web) - Reasonable Charges V3.24 Federal Register Notice, 10/01/18 (Inpatient)
(V3.24 FR Web) - Reasonable Charges V3.23 Federal Register Notice, 01/01/18 (Outpatient and Professional)
(V3.23 FR Web) - Reasonable Charges V3.22 Federal Register Notice, 10/01/17 (Inpatient)
(V3.22 FR Web) - Reasonable Charges V3.21 Federal Register Notice, 01/01/17 (Outpatient and Professional)
(V3.21 FR Web) - Reasonable Charges V3.19 Federal Register Notice, 10/01/16 (Inpatient)
(V3.19 FR Web) - Reasonable Charges V3.18 Federal Register Notice, 01/01/16 (Outpatient and Professional)
(V3.18 FR Web) - Reasonable Charges V3.17 Federal Register Notice, 10/01/15 (Inpatient)
(V3.17 FR Web) - Reasonable Charges V3.16 Federal Register Notice, 01/01/15 (Outpatient and Professional)
(V3.16 FR Web) - Reasonable Charges V3.15 Federal Register Notice, 10/01/14 (Inpatient)
(V3.15 FR Web) - Reasonable Charges V3.14 Federal Register Notice, 01/01/14 (Outpatient and Professional)
(V3.14 FR Web)
- V4.21 Data Table A (Inpatient) | V4.21 Data Table B (Inpatient)
- V3.27 Data Tables (Outpatient and Professional)
- V3.26 Data Tables (Inpatient)
- V3.25 Data Tables (Outpatient and Professional)
- V3.24 Data Tables (Inpatient)
- V3.23 Data Tables (Outpatient and Professional)
- V3.22 Data Tables (Inpatient)
- V3.21 Data Tables (Outpatient and Professional)
- V3.19 Data Tables (Inpatient)
- V3.18 Data Tables (Outpatient and Professional)
- V3.17 Data Tables (Inpatient)
- V3.16 Data Tables (Outpatient and Professional)
- V3.15 Data Tables (Inpatient)
- V3.14 Data Tables (Outpatient and Professional)
- Reasonable Charges V4.21 Data Sources (Inpatient)
- Reasonable Charges V3.27 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.26 Data Sources (Inpatient)
- Reasonable Charges V3.25 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.24 Data Sources (Inpatient)
- Reasonable Charges V3.23 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.22 Data Sources (Inpatient)
- Reasonable Charges V3.21 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.19 Data Sources (Inpatient)
- Reasonable Charges V3.18 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.17 Data Sources (Inpatient)
- Reasonable Charges V3.16 Data Sources (Outpatient and Professional)
- Reasonable Charges V3.15 Data Sources (Inpatient)
- Reasonable Charges V3.14 Data Sources (Outpatient and Professional)
- VA Medical Facility Locations, V4.21 (OCT 2020)
- VA Medical Facility Locations, V3.27 (JAN 2020)
- VA Medical Facility Locations, V3.26 (OCT 2019)
- VA Medical Facility Locations, V3.25 (JAN 2019)
- VA Medical Facility Locations, V3.24 (OCT 2018)
- VA Medical Facility Locations, V3.23 (JAN 2018)
- VA Medical Facility Locations, V3.22 (OCT 2017)
- VA Medical Facility Locations, V3.21 (JAN 2017)
- VA Medical Facility Locations, V3.19 (OCT 2016)
- VA Medical Facility Locations, V3.18 (JAN 2016)
- VA Medical Facility Locations, V3.17 (OCT 2015)
- VA Medical Facility Locations, V3.16 (JAN 2015)
- VA Medical Facility Locations, V3.15 (OCT 2014)
- VA Medical Facility Locations, V3.14 (JAN 2014)
- Cost-Based and Interagency Federal Register Notice, 10/01/20 | (Web)
- Cost-Based and Interagency Federal Register Notice, 10/01/19 | (Web)
- Cost-Based and Interagency Federal Register Notice, 08/28/18 | (Web)
- Cost-Based and Interagency Federal Register Notice, 08/29/17 | (Web)
- Cost-Based and Interagency Federal Register Notice, 07/07/16 | (Web)
Third Party Pharmacy Prescription Administrative Charge
Average national administrative cost for prescriptions for CY 2014 through CY 2020 can be viewed at Average Administrative Cost for Prescriptions.