This information is for community providers who bill VA for care delivered under Standardized Episodes of Care (SEOCs). The VA SEOC Billing Code List provides billing codes associated with each available SEOC.  

The SEOC Billing Code List identifies billing codes that require precertification, but the VA Precertification Portal (VAPP) must be used to validate that a code/service requires precertification and to submit a precertification request.   

How to use the SEOC Billing Code List

SEOCs provide a high-level summary of the typical scope of care and commonly associated billing codes for a referral. The billing codes listed on a SEOC are not intended to represent every service that may be provided. 

If a billing code is not listed on a SEOC, determine whether the service is within the scope and intent of the authorized referral, customary to the specialty, not investigational or experimental, and FDA-approved: 

• Services within scope may be billed using appropriate codes, even if the specific code is not listed. 
• Services outside scope of the authorized referral require additional VA approval before care is provided. 

When additional approval is needed, follow the Request for Service (RFS) process. 

SEOC billing codes 

VA generally follows standard Centers for Medicare & Medicaid Services (CMS) Medicare payment schedules and prospective payment system (PPS) methodology. Services coded on a SEOC typically use CMS Medicare codes. 

Claims are processed in accordance with CMS National Correct Coding Initiative (NCCI), Medically Unlikely Edits (MUE), and other related payment edits. 

Some billing code types are not included on SEOCs. Examples include: 

A billing code may also not appear on a SEOC when it is not appropriate to the specialty, is considered bundled or inclusive, is an add-on code, is used for reporting purposes only, or represents unlisted, experimental, investigational, or non-FDA-approved services. 

Non-CMS Medicare codes such as H-codes (CMS Medicaid codes), S-codes (commercial codes), and T-codes (category III codes for emerging technologies/investigational/experimental services) are included on SEOCs when the VA National Clinical Program Offices have made a determination of VA coverage.  Visit the Clinical Determinations and Indications (CDI) webpage for more information about CDIs.  

If a code is not listed on the SEOC: Services provided must be appropriate and necessary to accomplish the intent of the referring provider’s order/consult request. The SEOC describes the most likely scope of care necessary, but other services may be allowed in certain circumstances if necessary for completing the referral.