Page 8 - Medicare Benefit Policy Manual

• Furnished by a provider (Governmental or non governmental) or other person at
public expense pursuant to an authorization issued by a Federal agency (§50.1);

• Furnished by a provider of services or agency of the Federal government (§50.2);
and

• Paid for directly or indirectly by a Federal, State, or local governmental entity
(§50.3).

The A/B MAC (A) or (B) applies each of these exclusions separately, i.e., benefits are
excluded where any one of the exclusions applies.

50.1 - Items and Services Which a Non-Federal Provider Furnishes
Pursuant to an Authorization Issued by a Federal Agency
(Rev. 1, 10-01-03)
A3-3153.1, HO-260.3.B, B3-2309.2

50.1.1 - Veterans’ Administration (VA) Authorized Services
(Rev. 1, 10-01-03)
A3-3153.1.A, B3-2309.2, A3-3153.1.E, HO-260.3.B

Generally, an authorization issued by the Veterans’ Administration (VA) binds the VA to
pay in full for the items and services provided. No payment is made under Medicare for
such authorized services.

NOTE: Medicare can reimburse veterans for (or credit toward Medicare deductible or
coinsurance amounts) VA copayment amounts charged for VA authorized services
furnished by non-VA sources.

Medicare does not pay for any item or service rendered by a non-Federal provider
pursuant to an authorization issued by a Federal agency, under the terms of which the
Federal government agrees to pay for the services.

The VA may authorize non-Federal providers or private physicians or other suppliers to
render services at Federal expense. For example, the VA may pay for treatment of
veterans in non-VA hospitals for service connected disabilities and, in certain
circumstances, for nonservice-connected disabilities, provided the VA has given prior
authorization for the services. The VA may also agree to pay for emergency services
furnished a veteran who appears at a hospital without prior authorization, provided a
notification of the veteran’s admission and a request for authorization to provide care at
VA expense is submitted to the VA within 72 hours after the admission.

As a general rule, the VA does not authorize inpatient services at non-VA facilities for
treatment of nonservice-connected conditions. Accordingly, the A/B MAC (A) should
receive few, if any, requests for reimbursement for a VA copayment for treatment in a
non-VA provider. If a beneficiary requests reimbursement for the amount of the VA