Where does Find-A-Code get UCR Data?

by  Wyn Staheli, Director of Content - innoviHealth
Jul 25th, 2024

Find-A-Code provides UCR fees gathered from the US Department of Veterans Administration (VA) using Geographically-adjusted charges and THEIR 80th percentile conversion factors (CLICK HERE to learn about the 80th percentile conversion factor). The VA's UCR fees shown in Find-A-Code can be found on the code information page (see example below) and is available for performing a fee comparison with our UCR Pricing add-on. Reasonable charges are updated by the VA annually on or around January 1st each year.

The VA uses a variety of years and sources (including claims data — see “VA Fee Data Sources” below) as part of their process to establish their UCR fee schedule. Because there are so many different sources and years used, and we don't know their "secret sauce formulation," which can vary depending on the type of service (DME, Lab, Physician); it would be inaccurate to say that their particular formulation only looks at just the average of payer submitted charges in any single year.

The VA determines the amount of the national average administrative cost annually for the prior fiscal year (October through September) and then applies the charge at the start of the next calendar year.

It is important to note that there are some known problems when using only submitted claims data for fee analysis purposes. There are many providers who simply bill the amount they know a payer will pay (the contracted amount) — NOT what the real value of the service is. This practice can artificially deflate the UCR rates. That is why it is preferable to look at not only claims data, but to also review information used to arrive at Relative Value Units (RVUs) which is based on quantifiable measurements such as overhead, supplies, and professional services.

Note: Fee information based on claims data ONLY is NOT available within Find-A-Code.

We include the VA's data for our customers and have listed the VA's detailed information below; however, for additional questions on the VA's data and processes, please contact the Veterans Administration (see the “VA Fee Data Sources” section below).

How Does VA Create Reasonable Charges?

The following statement from the VA provides information about how they create the reasonable charges used in their data files:

VA Fee Data Sources

As mentioned earlier, the VA uses multiple sources to arrive at their "Reasonable Charges" amounts. These sources can be found in the Federal Register as well as their website. On their website, open the "Payer Rates and Charges" section. From there, select the type of data, such as "Reasonable Charges Data Sources," and select the most current version of the Inpatient or Outpatient and Professional files.

Rules and Notices such as the Federal Register are available and helpful in understanding where the Information used by the VA is coming from. Visit the "Payer Rates and Charges" page for information under Reasonable Charges Rules, Notices, & Federal Register.

After reviewing this information, if you have further questions, please contact the VA (see “How to Contact the VA About their Fee Information”.) 

ALERT: Be aware that any payer can have their own UCR schedule with their own unique formulations for reviewing and setting prices. UCR is not necessarily based on submitted claims data, although that CAN be a component of the payer’s process as it is with the VA.

How to Contact the VA About their Fee Information

Office of Community Care, Revenue Operations
Payer Relations and Services, Rates and Charges (10D1C1)
Veterans Health Administration (VHA), Department of Veterans Affairs
810 Vermont Avenue NW, Washington, DC 20420

(202) 382–2521 (not a toll-free number) or 
(800) 698-2411