Clinical Determinations and Indications
VA publishes Clinical Determinations and Indications (CDI) that outline clinical criteria and parameters for services and procedures Veterans may receive in the community. Community providers may use CDIs as a resource to help determine if a Veteran meets VA clinical criteria for these services and procedures.
NOTE: While CDIs are intended for community providers, VA providers and staff should also use them as a clinical review tool when determining clinical appropriateness.
Referencing CDIs before providing care will increase the speed at which VA processes requests for services from community providers. It also helps ensure the care being recommended meets VA clinical criteria.
Frequently asked questions
How do Clinical Determinations and Indications differ from Standardized Episodes of Care?
VA Clinical Determinations and Indications provide guidance about specific treatments, services or devices. They also outline the clinical criteria requirements to determine the medical necessity of a treatment or service.
In contrast, a Standardized Episode of Care (SEOC) allows VA to clearly request and deliver bundled health care services as part of a treatment plan within a specific period of time. VA issues SEOCs to community providers to clarify allowable services and procedures within a particular referral. You can view the SEOC billing code information on the Standardized Episodes of Care page.
What if I cannot find the appropriate clinical determination and indication, or a device or procedure is not covered by an existing CDI?
VA is in the process of creating more Clinical Determinations and Indications for community providers. If one is not available, please contact the Veteran’s local VA facility to obtain the clinical criteria for recommended care.
How often does VA publish new or updated clinical determinations and indications?
VA reviews and updates the Clinical Determinations and Indications regularly. Periodically check this webpage for an updated version.
CDI training
This training course is an introduction to Clinical Determinations and Indications and the Clinical Determinations Unit. This course covers the key uses, goals, and the impact of CDIs on both VA and community care stakeholders. Additionally, it reviews the CDI template and shares available resources and support for the end user.
Contacts and resources
To submit questions about published CDIs, complete the CDI Question Submission Form and email it to the address listed below.
NOTE: Only completed CDI Question Submission Forms will be reviewed at this email address. For Request for Service (RFS) submissions, follow the instructions on the RFS requirements page.