01/04/2021

VA Update: Spinal Decompression Eliminated from Standardized Episodes of Care, as of January 1, 2021

In December, the Veterans Health Administration (VA) announced that they had “reviewed its policy relating to chiropractic care” and will no longer reimburse spinal decompression (HCPCS code S9090) on VA standardized episodes of care (SEOC) for dates of service on or after January 1, 2021, because “it was determined that there was insufficient evidence regarding unique benefits of this service to justify continued reimbursement for this code.”

In lieu of spinal decompression, VA recommends using other types of reimbursable lumbar traction. As with any non-emergency Veteran community care, services must be authorized in advance. 

What is a Standardized Episode of Care (SEOC)?

Once the VA determines a Veteran’s eligibility for community care, they issue an approved referral to authorize a specific standardized episode of care (SEOC). An SEOC is a standardized bundle of services / procedures that relate to a specific category of care, such as chiropractic. Each specialty has its own SEOC template, which authorizes a standardized minimum amount of medically necessary care, including a specified number of visits, services, and duration, not to exceed one year.

SEOC Billing Code Information

The VA SEOC Billing Code List provides preapproved billing codes associated to the services within each available SEOC. The list also contains billing codes that require precertification from Optum Health, called "Precertification (Precert) Codes.” To access the billing codes, click here, scroll down to “Standardized Episodes of Care (SEOC) Billing Code Information,” accept the terms and conditions, and download the Excel file containing the codes.

The current VA fee schedule can be found here.

Questions about VA eliminating spinal decompression from the SEOC can be sent to VHAOCCDigitalEngagement@va.gov.

Sources:

VHA Office of Community Care Provider Advisor, “VA to Eliminate Spinal Decompression from Standardized Episodes of Care,” December 23, 2020

Optum Community Care Network, Standardized Episode of Care (SEOC)