VA CCN May 2026 Provider Pulse

Reminder: Timely Scheduling After VA Authorization is Received

Once an authorization is received from the Department of Veterans Affairs (VA), please make sure to schedule the Veteran’s appointment as soon as possible. Timely scheduling helps ensure Veterans receive the care they need without delays and supports continuity of care.

Want to speed up your scheduling system?
VA has announced that technology to more quickly schedule Community Care Network (CCN) appointments is operating at all VA facilities across the U.S.

According to VA, the External Provider Scheduling (EPS) technology provides VA employees instant access to the scheduling systems of all CCN providers participating in the program.

Using the participating provider information, VA employees can immediately schedule appointments for Veterans to meet their needs.

With availability of EPS, VA employees can more efficiently schedule numerous appointments daily with providers who have enabled access. VA says it will expand use of time-saving EPS technology with CCN providers in 2026.

Learn more: This recent VA news release explains how VA is improving Community Care Network appointment scheduling.

Abortion Coverage Exclusions Restored Under Federal Health Programs

The Department of Veterans Affairs (VA) does not provide abortions or abortion counseling except in cases where a physician certifies that the life of the individual is endangered if the pregnancy is carried to term. This action is required under the U.S. Department of Justice (DOJ) Office of Legal Counsel (OLC) opinion dated Dec. 18, 2025, and the Final Rule published on Dec. 31, 2025.

This guidance applies to all VA network providers and contractors, including those serving beneficiaries under the Civilian Health and Medical Program of VA (CHAMPVA).

What this Means for Providers

• VA does not provide abortions and abortion counseling services except in specific cases.
• Abortion and abortion counseling services are prohibited under both the VA Medical Benefits Package (38 CFR 17.38) and CHAMPVA (38 CFR 17.272).

Important Exceptions for Life-Saving Services

The changes to the medical benefits package and CHAMPVA do not prohibit providing care to pregnant women in life-threatening circumstances, including treatment for ectopic pregnancies or miscarriages. VA provides care in the following circumstances:

• Ectopic Pregnancy. An ectopic pregnancy is any pregnancy occurring outside the uterine cavity. These are never viable; care for ectopic pregnancies continues to be covered under the medical benefits package.
• Spontaneous Abortion. A spontaneous abortion (SAB), also known as a miscarriage, is the spontaneous loss of a fetus before the 20th week of pregnancy. Medically necessary procedures for the management of spontaneous abortion continue to be covered medical benefits.
• Other Life-Saving Treatment. Pregnant Veterans may experience serious medical conditions requiring treatment to save the Veteran’s life. The exclusion on abortion does not bar necessary treatment to save a Veteran’s life when their clinician determines the care is necessary to save the Veteran’s life, even if this requires an intervention that would end the pregnancy. Care in these circumstances is covered under the medical benefits package and should not be delayed.
• Informed consent. The bar on abortion counseling does not bar obtaining informed consent from a patient when life-saving treatment is necessary.

For more information, or to read the final ruling visit the Federal Register’s Reproductive Health Services page.

New Payment Guidelines in Effect for CCN Providers

The Department of Veterans Affairs (VA) has released formal payment guidance covering three areas: Evaluation and Management (E/M) billing for non-physician providers, hearing aid dispensing fees, and Intensity-Modulated Radiation Therapy (IMRT) planning and delivery.

E/M Billing for Non-Physician Providers
Non-physician providers, including NPs, PAs, CNSs, CNMs, chiropractors, and acupuncturists, are eligible to bill E/M services under CCN. Eligibility is determined by the rendering provider’s taxonomy code. If the taxonomy on the claim is not approved for E/M, the claim will be denied.

Audiology & Hearing Aid Dispensing Fees
The hearing aid dispensing fee covers a bundle of services including fitting, programming, the initial office visit, and ear mold impressions. These cannot be billed separately. Providers should note certain codes are not reimbursable and submitting two codes on the same date of service will result in a denied claim.

Intensity-Modulated Radiation Therapy Planning & Delivery
Effective Jan. 1, 2026, IMRT claims are subject to new payment controls. Several codes are bundled into the 77301 Ambulatory Payment Classification (APC) payment and cannot be billed separately.

More information on each of these topics will be shared in the coming weeks through a series of quick reference guides.

VA CCN Provider Handbook Updates

1. All instances of “abortion” will be modified to say “pregnancy termination.”
2. A new section will be added to the Billing and Claims section of the CCN Handbook:

Understanding VA CCN Referrals and Billing Requirements
As a provider rendering care to Veterans under CCN, please follow the guidelines below for obtaining referrals, billing properly, and aligning services with VA-approved care.

Ensuring the Correct Referral is Issued
Providers are responsible for verifying the referral issued by VA aligns with the services they can render. Before accepting a referral, please review the Standardized Episode of Care (SEOC) and confirm that the services fall within your scope of practice and capability.

Providers must also ensure that services rendered are:

• Authorized within the SEOC, including the number of visits/hours/procedures specified.
• Billed according to the authorization received, even if the SEOC outlines broader service categories.

SEOC and Fee Schedule Limitations
The presence of a CPT/HPCS code on the SEOC or VA Fee Schedule (VA FS) does not guarantee reimbursement. Providers must follow CMS billing guidelines unless directed by VA or your contract with TriWest.

Some services may be reimbursed by VA but not covered under CMS rules based on VA-specific policies and authorization limits.

Coverage vs. Reimbursement: Know the Difference

• CMS Covered: Item/device/service is recognized by Medicare as medically necessary under certain conditions.
• CMS Reimbursable: CMS guidelines that determine if a covered item/device/service is payable. For example, status B codes are covered by CMS but not separately reimbursable as payment is included in another service.
• VA Covered: VA may cover an item/device/service that is not covered by CMS and reimburse it at a VA-specific rate (VA FS, rate waiver or % of billed). Medicare coverage of a procedure code does not dictate whether the service is covered by VA.

VA or TriWest may initiate a recoupment. Providers should retain documentation to support all billed services.

Additional Questions

If a code is on the VA Fee Schedule, does that mean it will be reimbursed?
No. The VA Fee Schedule only indicates potential reimbursement rates. Reimbursement is contingent upon proper authorization and billing guidelines.

Can additional visits beyond what is authorized be provided if the SEOC lists a broader number?
No. The authorization dictates the exact number of visits/hours/procedures approved. Rendering additional services without a separate authorization may result in denied claims or recoupment.

What should I do if I receive an audit request?
Provide the requested medical records, billing documentation, and authorization details to the requestor.

How do I avoid recoupments?
Ensure that the service is authorized in the referral and claims are billed according to VA CCN and CMS guidelines.

What if the date(s) services were rendered are not covered by the approved referral?
Providers are responsible for ensuring an approved authorization is in place prior to rendering services. Providers are also responsible for the timely submission of a Request for Services (RFS) to VA.

What if I need to render additional services?
If a provider determines that additional services are needed beyond what is authorized in the initial referral, they must submit an RFS to VA. Providers must await VA approval before rendering services.

Failure to adhere to these guidelines may result in claim denials or recoupments upon audit. Providers should verify authorization details before rendering services to ensure reimbursement eligibility.