Attachment 2 -.Code Set Example.docx
DOCX document 16 KB Posted
- Attached to
- Q601--RFI – Information Sought: Code Sets
- Solicitation number
- 36C10G26Q0063
About this file
This is a Request for Information (RFI) issued by the Department of Veterans Affairs seeking information about the availability and technical capabilities of qualified sources to develop, maintain, and regularly deliver comprehensive billing code sets. The VA is not currently seeking proposals and will not accept unsolicited proposals at this time; all responses must be submitted solely as informational materials and cannot form a binding contract. Responses are due by May 14, 2026 at 3:00 PM Eastern and must be emailed to Contracting Officer Jeffery Fithen (Jeffery.Fithen@va.gov) and Contract Specialist Justin Sink (Justin.Sink@va.gov), with the RFI number 36C10G26Q0063 and project title "Code Sets" referenced in the email subject line.
The attachment provides an example code set for Cardiology Community Care Referral Guidelines (CCRG), demonstrating the structure and content the VA is evaluating. The example outlines allowable services without prior authorization, including outpatient evaluation and management services, diagnostic imaging tests (up to 5), diagnostic labs (up to 15), diagnostic studies (up to 10), and device interrogations or programming (up to 6), each with corresponding VA Code Set designations and quantity limits. The example also addresses in-clinic medications, including FDA-approved infusions and injections administered at specialty care infusion centers, medical provider offices, or specialty care clinics, with provisions for obtaining formulary approval for unlisted medications. All costs associated with responding to this RFI are the sole responsibility of the respondent, and all submissions will be treated as business confidential materials and become Government property.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment 1 - RFI Questions.docx | DOCX document | |
| 36C10G26Q0063.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Code Set Example: Cardiology Community Care Referral Guideline (CCRG)
ALLOWABLE SERVICES RELATED TO THIS SPECIALTY THAT DO NOT REQUIRE PRIOR AUTHORIZATION
1. Outpatient evaluation and management (E/M) services related to the specific condition noted on the consult/referral order within the duration of the VA authorization.
The scope of services must be related to the referred condition on the consult/referral order, FDA‑approved, medically necessary, considered usual and customary for the specialty or subspecialty, evidence‑based, within generally accepted standards of medical practice, and within the authorization duration.
a) Up to 5 cardiac‑related diagnostic imaging tests Code Set: VA CodeSet 00002 Quantity Limit: 5
b) Up to 15 cardiac‑related diagnostic labs Code Set: VA CodeSet 00003 Quantity Limit: 15
c) Up to 10 cardiac‑related diagnostic studies (e.g., stress tests, echocardiograms) Code Set: VA CodeSet 00004 Quantity Limit: 10
d) Up to 6 device interrogations and/or programming (e.g., AICD, pacemaker, ventricular assist device) Code Set: VA CodeSet 00005 Quantity Limit: 6
IN‑CLINIC MEDICATIONS: FDA‑approved, clinically indicated in‑clinic infusions or injections may be administered by the community provider if related to the referred condition and appropriate to the specialty. Permitted settings include:
• Specialty care infusion centers
• Medical provider offices
• Specialty care clinics
For medications NOT LISTED on the prior authorization list: The community provider must obtain a New VA Formulary Advisor or Specialty Care Criteria for Use (CFU). An RFS is not required when providing a medication that is not listed on the prior authorization list.
File details come from the government source that posted it. Updated .