VA CCN August 2025 Provider Pulse

Reminder: Follow VA SEOC Guidelines for Veteran Massage Therapy

Under VA’s Community Care Network (CCN), please remember the session structure outlined in the massage therapy Standardized Episode of Care (SEOC).

The massage therapy SEOC indicates that a Veteran has 12 total allowable visits. The initial session is 60 minutes (30 minutes for the first assessment, and 30 minutes for the massage).

If two 30-minute sessions must be combined into an extended 60-minute visit, please include consistent documentation in the Request for Service that supports this care for that duration of time.

For more information and to view the massage therapy SEOC, refer to the VA SEOC Billing Code list.

Attention Providers: Duloxetine Recall Announced

The U.S. Veterans Health Administration (VHA) declared a national recall of Duloxetine due to the presence of Nitrosamine Drug Substance Related Impurity (NDSRI), N-nitroso-duloxetine, above the proposed interim limit.

Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) that is specified for major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain.

The voluntary recall of the McKesson-based product involves Duloxetine DR CP60MGBRECK1000 from Lot 230836C with an expiration date of 2/28/2026. The NDC number is 51991074810, the UPC number is 35199174810, and the McKesson Item Number is 3424496.

Providers should report any adverse patient reactions from use of the affected product through the Computerized Patient Record System (CPRS).

Adverse events should also be reported, as appropriate, to the VA Adverse Drug Event Reporting System and MedWatch, the Food and Drug Administration’s medical product safety reporting program for health professionals, patients, and consumers. Reports can be made by calling 800-FDA-1088, faxing information to 800-FDA-0178, going online, or by mail.

Review Qualifications for the High Performing Provider Designation

The Department of Veterans Affairs (VA) designates Community Care Network (CCN) providers who excel in a set of standard health care evaluation metrics as High Performing Providers (HPP). The HPP designation is one, but not the only, measure of provider practice quality.

Provider performance is analyzed and monitored against a standard set of quality metrics determined by TriWest, including clinical outcomes, patient satisfaction, cost-effectiveness, and adherence to established guidelines. Providers can achieve the HPP designation by consistently meeting or exceeding measures of performance expected under the guidelines set forth by Blue Health Intelligence and Centers for Medicare and Medicaid Services (CMS).

VA staff take the HPP designation into account during the Veteran appointment scheduling process to help Veterans select a community provider that best meets their needs.

Scoring and Eligibility

VA’s HPP designation applies to individual practitioners, practitioners in a group setting, and institutional providers, such as hospitals. The three types of providers are scored differently:

Individual providers are evaluated based on Primary Care and Specialty Measures from Blue Health Intelligence.
Provider practice groups are scored as a single entity, and providers in those groups are assigned the score of the overall group.
Institutional providers are scored on a selection of CMS measures from the Hospital Compare system.

No action is required from providers. The HPP designation is informative and does not serve as an endorsement or a guarantee of a provider’s ability to provide health care services. Contact us to learn more about HPP eligibility.

Resources

A summary of your specific provider metric results is available on request by completing the HPP Inquiry Form on the TriWest Payer Space on Availity.

For more information on the HPP designation, please review the HPP Quick Reference Guide and CCN Provider Handbook. Providers should send the completed HPP Inquiry Form to CQHPP@TriWest.com.

30 Updates to CCN SEOCs Implemented August 1

The Department of Veterans Affairs (VA) continues to demonstrate its commitment to providing industry-leading care by identifying opportunities to ensure better clinical outcomes under the Community Care Network (CCN).

Following a comprehensive analysis of the available 386 Standardized Episodes of Care (SEOC), VA has updated 30 existing SEOCs as part of a nationwide rollout. While many of the impacted SEOCs had minor coding changes, all 30 received an extension to the authorized duration of care, up to the maximum allowed 365 days. This means you, the provider, will receive administrative documents less frequently, and send fewer requests to VA for additional care.

VA created the SEOC model to authorize procedures relating to a particular category of care to ensure Veterans receive specific and appropriate care.

For a list of current SEOCs and their billing codes, visit VA’s Community Care web page, then press “ACCEPT” to view the current list of SEOCs.

Please note: These updates do not impact Veterans’ eligibility for community care. Veterans can still choose their own care options at a VA facility, from a community provider, or by using one of VA’s virtual options. These changes will also not impact any SEOC currently in effect as part of a Veteran’s treatment plan.

As a reminder, the presence of a CPT/HPCS code on the SEOC or VA CCN Fee Schedule does not guarantee reimbursement.

Providers are responsible for ensuring an approved authorization is in place prior to rendering services, and for submitting Request for Services (RFS) to VA in a timely manner. Providers should also verify authorization details before rendering services to ensure reimbursement eligibility.