VA Family Medical - CHAMPVA 4+

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), is for individuals who are either the spouse or children of a disabled Veteran, or the surviving spouse or child of a Veteran who has died AND do not qualify for TRICARE.

The Department of Veterans Affairs (VA) CHAMPVA mobile application (app) is designed for medical service providers (VA and private practice) and beneficiaries as they plan care and medical procedures. Beneficiaries and providers use the app individually, or together during a patient encounter, to determine whether the VA will pay for care delivery.

The CHAMPVA app uses several different medical code sets to determine if services and/or equipment are covered. Over 270,000 individual medical codes are listed in the included databases. Medical code sets include:

Current Procedural Terminology (CPT) codes, which describe medical, surgical, and diagnostic services. CPT coding identifies services rendered.

ICD-10 codes, which relate to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. The CHAMPVA app uses ICD-10-CM data from the Centers for Medicare and Medicaid Services (CMS).

The Healthcare Common Procedure Coding System (HCPCS) codes, which provide a standardized coding system for describing the specific items and services provided in the delivery of health care. Such coding is necessary for CHAMPVA, Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner.

Durable Medical Equipment (DME) codes refer to equipment that can withstand repeated use, is primarily used to serve a medical purpose, is generally not useful in the absence of an illness or injury and is appropriate for use in the home. DME codes are included with HCPCS Codes.

The national drug codes (NDC) are unique 10-digit, three segment numerical codes that identify drugs intended for human use. The first segment is a 4 to 5 digit, Food and Drug Administration (FDA) assigned labeler code to identify the firm that manufactures or distributes a drug. The second segment is the product code, which identifies the drug, including the specific strength, dosage form, and formulation. The third segment, the package code, identifies package sizes and types.

For billing purposes an 11-digit 5-4-2 format code is used based on the NDC code. The CHAMPVA app uses the information published by the FDA and converts the NDC code to the billing code.

Medical codes are searchable via the alphanumeric code, name or description.

Once a desired medical code is identified, a patient or provider may select it to determine if it is Covered by CHAMPVA. Results DO NOT constitute an authorization by the United States Department of Veterans Affairs (VA) for any purchase.

The CHAMPVA program guide is included that provides a more detailed explanation of CHAMPVA benefits. The CHAMPVA Guide contains links to applicable websites as well as phone numbers that can be called from your phone by tapping on the number. This guide is searchable via the table of contents as well as by the index. For convenience a Portable Document Format (pdf) version is also included.

The CHAMPVA app also includes a facility locator that allows searching by type of facility to find providers near you out of the over 2400 VA facilities nationwide. Additionally, providers and pharmacies that participate in the VA Community Care Program may be searched to ensure that you get the best care possible.