Where does Find-A-Code get UCR Data?

by  Wyn Staheli, Director of Content - innoviHealth
Jul 25th, 2024

Find-A-Code provides UCR fees gathered from the US Department of Veterans Administration (VA) using Geographically-adjusted charges and the 80th percentile conversion factors; this information can be found on the code information page (see example below) and is available for performing a fee comparison with our UCR Pricing add-on. Reasonable charges are updated by the VA annually on or around January 1st each year.

There are a variety of sources (including claims data) and years that are used when the VA creates the information available in their UCR database. Because there are so many different sources and years used, and we don't know their "secret sauce formulation," which can vary depending on the type of service (DME, Lab, Physician); it would be inaccurate to say that their particular formulation only looks at just the average of payer submitted charges in any single year.

It is important to note that there are some known problems when using only submitted claims data for fee analysis purposes. There are many providers who simply bill the amount they know a payer will pay (the contracted amount) — NOT what the real value of the service is. These claims can artificially deflate the UCR rates. That is why it is preferable to look at not only claims data, but to also review information used to arrive at Relative Value Units (RVUs) which is based on quantifiable measurements such as overhead, supplies, and professional services.

Note: Fee information based on claims data ONLY is NOT available within Find-A-Code.

We include the VA's data for our customers and have listed the VA's detailed information below; however, for additional questions on the VA's data and processes, please contact the Veterans Administration (see the “VA Fee Data Sources” section below).

How Does VA Create Reasonable Charges?

The following statement from the VA provides information about how they create the reasonable charges used in their data files:

VA Fee Data Sources

Rules and Notices such as the Federal Register are available and helpful in understanding where the Information used by the VA is coming from. Visit the "Payer Rates and Charges" page for information under Reasonable Charges Rules, Notices, & Federal Register.

Data sources used by the VA when assigning UCR fees can be found on the "Payer Rates and Charges" page under "Reasonable Charges Data Sources."

After reviewing this information, if you have further questions, please contact the VA (see “How to Contact the VA About their Fee Information”.) 

Understanding the 80th Percentile

Note: "80th percentile" charges are not the same as a fee multiplier.

When the VA performs its survey of fee amounts, the fee amount they chose as the UCR amount is in the middle of at least 80% of the fee amounts reported. Like in a bell curve that covers X%, the middle or peak of the bell curve is the amount they chose.

The VA determines the amount of the national average administrative cost annually for the prior fiscal year (October through September) and then applies the charge at the start of the next calendar year. Below are some links to the Federal Register and data sources from the VA Website.

How to Contact the VA About their Fee Information

Office of Community Care, Revenue Operations
Payer Relations and Services, Rates and Charges (10D1C1)
Veterans Health Administration (VHA), Department of Veterans Affairs
810 Vermont Avenue NW, Washington, DC 20420

(202) 382–2521 (not a toll-free number) or 
(800) 698-2411