38 CFR 17.273 – Preauthorization
Preauthorization or advance approval is required for any of the following, except when the benefit is covered by the CHAMPVA beneficiary‘s other health insurance (OHI):
Terms Used In 38 CFR 17.273
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
(a) Non-emergent inpatient mental health and substance abuse care including admission of emotionally disturbed children and adolescents to residential treatment centers.
(b) All admissions to a partial hospitalization program (including alcohol rehabilitation).
(c) Outpatient mental health visits in excess of 23 per calendar year and/or more than two (2) sessions per week.
(d) Dental care. For limitations on dental care, see § 17.272(a)(21)(i) through (xii).
(e) Organ transplants.
(e) Organ transplants.
(f) CHAMPVA will perform a retrospective medical necessity review during the coordination of benefits process if:
(1) It is determined that CHAMPVA is the responsible payer for services and supplies but CHAMPVA preauthorization was not obtained prior to delivery of the services or supplies; and,
(2) The claim for payment is filed within the appropriate one-year period.