Attention A T users. To access the menus on this page please perform the following steps.
1. Please switch auto forms mode to off.
2. Hit enter to expand a main menu option (Health, Benefits, etc).
3. To enter and activate the submenu links, hit the down arrow.
You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.
Locator
Contact
Search
Search
Menu
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 Rules, Notices, & Federal Register
- 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)
Reasonable Charges Data Tables
- 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 Data Sources
- 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
- 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 Rate
- 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.
