Research Reimbursement Policy
Reimbursing VA for Clinical Costs
This procedure applies to all extramurally-funded research projects administered by SIBCR, regardless of source (e.g., private industry, voluntary health organizations, NIH or other federal grants). It covers all research projects approved for conduct by VAPSHCS that involve provision of medical care services, such as radiology, cardiology, laboratory medicine, or others as defined by service lines.
Research use of such services consists of:
1. Services provided over and above standard medical care for an eligible veteran;
2. Services provided to a non-veteran participating in a research project (except those provided under 38 CFR §17.85).
Prior to approval of a study, investigators should notify each required service of their intent and seek agreement with them to collaborate in the study. This review and approval will ensure the service has the wherewithal to provide the required study procedures.
At this stage, the investigator or designee should verify the exact CPT or LMIP code for the procedure requested and the charge per procedure. The charge will be the standard rate of reimbursement as set by agreement between SIBCR and VAPSHCS, which is determined to be 90% of the current Medicare rate. Note that Pharmacy and the Clinical Research Unit have separately determined charge schedules that are not encompassed by this procedure.
These written agreements, signed by the service line leader or designee and by the investigator and study coordinator, become a part of the approval packet for the R&D Committee.
After the approved study commences, each providing service must receive a completed Request for Procedure or Test form 
DOC for each research subject receiving a medical care procedure or test that falls under category 1) or 2) above. On a periodic basis, the service will compile an invoice of charges from research usage and present it to SIBCR for payment.
Rate Exceptions for Medical Service Reimbursement:
Occasionally a research project may be proposed that would significantly further the VA mission but has unusually limited support from its sponsor. If the cost of medical service reimbursement is a specific obstacle to the conduct of such a study, the PI may request a special, project-specific exception to the standard rate.
The PI must prepare a written request for an exception to the rate, describing the particular value of the proposed project to VA patients and VA care, the source of funding and the nature of its limitations, and a justification of the rate that is being requested. The written request will be reviewed by the relevant service line leader, the VAPSHCS Deputy Director or designee, and the SIBCR Executive Director. These individuals will confer with each other and the PI and arrive at a consensus decision as to whether the reduced rate is granted. Such a rate may only be applied to the specific research project for which it was approved, and must be approved prior to the project’s submission to the R&D Committee.