December 2025 Provider Pulse

2026 VA Fee Schedule Now Available

The annual Department of Veterans Affairs Fee Schedule (VAFS) is now published and available on the VA Fee Schedule web page.

The goal of VAFS is to ensure fair reimbursement for all providers when Medicare maximum allowable rates are not available. VA continues to modernize the reimbursement methodology to ensure maximum allowable VAFS rates are consistent with industry reimbursement benchmarks, and ensure that most services have maximum allowable rates. If you have questions or would like to provide feedback regarding updated rates, you can submit an inquiry directly to VA.

VA reimburses medical services, hospital care and extended care services up to the maximum allowable rate. The maximum allowable reimbursement rate is generally the applicable Medicare rate published by the Centers for Medicare and Medicaid Services. When there is no Medicare rate available, VA reimburses the lesser of VAFS or billed charges. Reimbursement rates are subject to change.

VA’s Digital Scheduling System for CCN Providers

The Department of Veterans Affairs (VA) is rolling out the External Provider Scheduling (EPS) system, a digital platform designed to improve and simplify the appointment process for providers caring for Veterans under the Community Care Network.

EPS can help you streamline scheduling by using automated scheduling grids, reducing the time spent waiting for authorization numbers and eliminating additional phone calls. EPS provides referral authorization numbers at the time of booking so you can save time on office work.

Security settings only allow VA access to your availability in your scheduling system, ensuring no electronic health record information is shared. Your data remains exclusively yours.

Benefits to Your Organization

Save time for your staff.
Maintain your current system and workflows.
No fees.
Immediate referral authorizations.

Benefits for Veterans

Reduced appointment wait times.
More timely access to care.
Enhanced appointment accuracy.

With faster scheduling and real-time authorization numbers, providers can focus on delivering quality care to Veterans.

For more information on EPS, see VA’s EPS Overview Fact Sheet.

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 consider the HPP designation during the Veteran appointment scheduling process to help Veterans select a community provider to meet 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.

There is no action on the part of providers. The HPP designation is informative and not 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’s 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.

Sun Pharma Issues Recall of Certain Lisdexamfetamine Capsules Due to Quality Testing Issue

Sun Pharmaceutical Industries has announced a voluntary recall of specific lots of lisdexamfetamine capsules after the products failed dissolution testing, a standard quality test used to ensure medication releases properly in the body.

Lisdexamfetamine is a central nervous system (CNS) stimulant approved for the treatment of attention-deficit hyperactivity disorder (ADHD) and moderate to severe binge eating disorder.

While no serious safety concerns have been confirmed at this time, patients using these specific lots may not experience the full benefit of treatment. Providers are encouraged to report any suspected adverse drug reactions in the Computerized Patient Record System’s (CPRS) Allergies/Adverse Reactions field, and/or via local reporting mechanisms. Adverse events should also be reported to VA’s Adverse Drug Event Reporting System (ADERS) and FDA MedWatch: