Veteran and Family Member Program CHAMPVA

CHAMPVA Pay screen shows search for 'MIGRAINE,' displaying covered ICD-10 & CPT codes, a disclaimer, and navigation options below.

CHAMPVA Pay screen shows search for '0DXU0ZV,' listing conditions, restrictions, a contact number, a disclaimer, and navigation options.

CHAMPVA Pay screen shows search for 'T1040,' displaying a red notice stating it's not covered, with navigation options below.

CHAMPVA Pay screen shows search results for 'ADA' via the dropdown feature, with navigation options at the bottom.

CHAMPVA Guide screen shows different sections available to read through within guide.

CHAMPVA Guide screen shows "FILE A CLAIM" typed within search box with results appearing below.

Providers Types screen shows the various types of VA providers available to search through.

Providers screen shows zoomed in map displaying various VA Clinics in the area, with distance and clinic information.

Providers screen shows zoomed in map displaying various pharmacies in the area, with distance and pharmacy information.

About CHAMPVA screen shows Version, Build, Created date. Below is a clickable button to review End User License Agreement.

Introduction

This Veteran and Family Member Program (VFMP) mobile application is for spouses, dependents, or survivor Veterans who meet certain service-connected disability requirements - These spouses, dependents, and survivors may be eligible for the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Veterans, and providers, use it to look up whether VA will reimburse for a code, not reimburse, or reimburse with conditions. The app checks American Dental Association (ADA), Current Procedural Technology (CPT), International Classification of Diseases, Tenth Revision (ICD-10), National Drug Code (NDC), and Healthcare Common Procedure Coding System-Durable Medical Equipment (HCPCS-DME) codes.

Features

See coverage status: covered, covered with conditions, not covered or requiring a call for more information.
Guide to CHAMPVA including websites, coverage and contact information.

Training Materials

Check Medical Codes

The VFMP App landing page, CHAMPVA Pay screen features several different ways to search for medical codes. Medical codes are searchable via the alphanumeric code, name, or description. Once a desired medical code is identified, the user may select it to determine the participation status of individual codes for use by a Veteran's beneficiaries and/or medical providers. In addition to searching for medical codes individually via the Search box, another feature on the CHAMPVA Pay screen is the option to search for all codes associated with each code type: ADA, CPT, ICD-10, HCPCS/DME, and NDC.

Three different CHAMPVA Pay Screen captures in one image. Features three different ways to search for medical codes. Searching by drug name/description, alphanumeric code, or selecting one or more Code Types from the drop down feature.

CHAMPVA Pay – See Coverage

Coverage status includes: covered, covered with conditions, not covered, or requiring a call for more information. In the Search box at the top of the CHAMPVA Pay screen, an alphanumeric code, name, or description can be entered, followed by selecting the magnifying glass icon. If the entered code, name, or description is associated with a valid medical code, it will appear below the Search box along with its details, including the code type, code number, and code description. Selecting the box containing the code information will display a coverage status note above. To search for all codes associated with a specific code type, any existing text in the Search box should be cleared by backspacing or selecting the X icon. Below the Search box, the Code Types dropdown field provides options to filter by specific code types, where the desired code type(s) can be selected by checking the corresponding boxes. The magnifying glass icon initiates the search, displaying a comprehensive list of medical codes associated with the selected code type(s).

Three different CHAMPVA Pay Screen captures in one image. Features the different coverage status from left to right, Covered, Covered with Conditions, Not Covered.

CHAMPVA Guide

The CHAMPVA Guide screen provides important information about CHAMPVA, listing topic areas by section. Click on each section to view detailed information such as eligibility requirements, how to file a claim, and important phone numbers, just to list a few. The sections within this screen are color coordinated to match the va.gov PDF version of the Guide. To quickly search for a word or topic, there is a Search box appearing at the top of the CHAMPVA Guide that allows the user to type what they are specifically looking for. As the user is typing, if the word or phrase is listed anywhere within the Guide, results will populate below the Search box. Simply click on the result(s), if any, to view the associated information and see where it is located in the Guide.

Providers

The Providers screen utilizes location services to identify various types of local VA facilities. VA resources available include community pharmacies, medical centers and clinics, benefit locations, and Vet Centers.

FAQs

What is the Veteran and Family Member Program - CHAMPVA App, and why should I use it?

The Veteran and Family Member Program (VFMP) – CHAMPVA Mobile Application (App) is an interactive tool to help Veterans, Veteran beneficiaries and/or medical providers look up a medical code to see if it is covered by CHAMPVA.

What medical codes does the VFMP App accept?

The app accepts American Dental Association (ADA), Current Procedural Technology (CPT), International Classification of Diseases, Tenth Revision (IDC-10), National Drug Code (NDC), and Durable Medical Equipment (HCPCS-DME) codes and returns the reimbursement status.

Who can use the VFMP App?

Anyone can access the VFMP – CHAMPVA App and check on reimbursement statuses, including a Veteran’s beneficiaries and/or medical providers.

How do I look up a medical code to see if it is covered by CHAMPVA?

On the CHAMPVA Pay screen, there are five different categories of medical codes. Medical codes are searchable via the alphanumeric code, name, or description. In the Search box, type what you are looking for and tap the magnifying glass icon to initiate the search. Once a desired medical code is identified, the user may select it to determine the coverage status. In addition to searching for medical codes individually via the Search box, another feature on the CHAMPVA Pay screen is the option to search for all codes associated with each code type: ADA, CPT, ICD-10, HCPCS/DME, and NDC. 

ADA Code – American Dental Association codes are used for dental procedures. The code must be 5 alphanumeric characters (e.g., D6607)
CPT Code – Current Procedural Terminology codes are used for billing outpatient and office procedures. The code must be 3-7 alphanumeric characters (e.g., 98941).
ICD-10 Code – International Classification of Diseases, Tenth Revision codes are used to classify and code all diagnoses, symptoms and procedures. The code must be 1-8 alphanumeric characters (e.g., S72044G).
HCPCS/DME Code – Healthcare Common Procedure Coding System/Durable Medical Equipment codes are used to identify medical equipment used for treatment. The code must be 3-7 alphanumeric characters (e.g., A4265).
NDC Code – National Drug Code codes are used for identification of human drugs. The code must be 10-13 Numerals & Dash only (e.g.,12345-6789-12).

What are the different possible statuses for CHAMPVA coverage?

There are three options for the participation status:  

Yes – This is covered by CHAMPVA.
Yes with conditions. This is part of CHAMPVA, but there are restrictions. You are advised to contact the CHAMPVA service center for more details. To learn more, call the service center at: 1(800)733-8387.
No – This is not covered by CHAMPVA.

NOTE: Results of any search using the VFMP App are current at the time of use only and do not constitute an authorization by VA to purchase any drug, medical treatment or piece of durable medical equipment. All reimbursement rates quoted by this app are subject to change.

What do I do if I need additional information or help?

To access the app’s built-in resources, tap the About CHAMPVA tab on the bottom right corner of the app.

CHAMPVA Help Line Information: If you need help with the VFMP App, dial 1-800-733-8387 to speak with a VA representative. For TTY assistance, dial 711. You should never use this app in an emergency. If you encounter an emergency, call your local medical center or dial 911 immediately.

What is VA Mobile?

VA Mobile is an initiative that aims to improve Veterans’ health by providing technologies to expand care beyond the traditional office visit. As part of VA Mobile, VA is releasing a series of secure apps that take advantage of the popularity of wireless technologies to support Veterans, caregivers, and VA care teams.

Where can I find additional information about other available VA Mobile Apps?

Additional information about other available VA Apps can be found on mobile.va.gov/appstore as well as mobile.va.gov in the VA Mobile Apps General FAQs.

Help

For help with this app, contact the apps developers at:
Website: CHAMPVA website
Email: CHAMPVAMOBILEAPPSUPPORT@va.gov