What Is a CHAMPVA Preauthorization Or Prior Authorization for?

Preauthorization means getting a pre-approval before a covered service or supply is given.  Normally, CHAMPVA does not need preauthorization for a beneficiary to get treatment.  However there are instances where it is required.  The VA does this to ensure that the service/supply is medically necessary and appropriate; that it is covered; and that it can be obtained at a reasonable cost to the government.

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When CHAMPVA Requires Preauthorization

You must get preapproval from the VA for:

  • Durable Medical Equipment (DME) if the total cost of buying or renting it costs $2,000 or more
  • Dental care
  • Organ transplants
  • Hospice care
  • Mental health care (including substance abuse)

When a Provider Asks for Preauthorization

If a provider wants to get pre-approved even for services/supplies not listed above, they may do so by contacting CHAMPVA directly.  The VA will let them know based on information given if it is covered or not.  For a general guide, you can show your provider your copy of the CHAMPVA Handbook as well and refer them to the lists of covered and non-covered services.

When Preauthorization Is Waived – the CITI Program

The CHAMPVA Inhouse Treatment Initiative program lets CHAMPVA beneficiaries receive free health care at participating VA medical facilities.  If you do get treated at such a facility, you don’t need preauthorization for DME’s and services listed above– except for the following:

  • Dental care
  • Organ transplants

Also, if you have Medicare or other health insurance that pays before CHAMPVA, and it has approved it, mental health care does not need CHAMPVA preauthorization.

Preauthorization Address

According to the CHAMPVA fact sheet on DME’s, the contact address for requesting authorization for all cases except mental health care is:

VA Health Administration Center
CHAMPVA
ATTN: Preauthorization
PO Box 469063
Denver, CO 80246-9063

Phone: 1-800-733-8387

For mental health, you must contact the CHAMPVA mental health contractor at:

Magellan Behavioral Health
CHAMPVA
PO Box 3567
Englewood CO 80155

Phone: 1-800-424-4018 (domestic)
1-720-529-7400 (international)

For Urgent Need of Durable Medical Equipment

Preauthorization for DME’s can take some time especially if requested via mail.  For urgent cases, CHAMPVA can give a preapproval over the phone.  If immediate use is needed and the item still has to be purchased, CHAMPVA can also authorize rental in the meantim.

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