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marina53

CHAMPVA + annual physical

Question

I can't seem to find an answer to this question but does CHAMPVA pay for an annual physical exam? Last physical exam I had CHAMP denied . 

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Per your request:

http://www.va.gov/PURCHASEDCARE/docs/pubfiles/policymanuals/champva/chapter2/1c2s23-2.htm

TRANSMITTAL #: 128

DATE:  12/23/2011

TRICARE CHANGE#: N/A

CHAMPVA POLICY MANUAL

CHAPTER: 2

SECTION: 23.2

TITLE: ROUTINE PHYSICAL EXAMINATIONS

AUTHORITY:  38 CFR 17.270(a) and 17.272(a)

RELATED AUTHORITY:  32 CFR 199.4(g)(37)

I. EFFECTIVE DATE(S)

Effective October 1, 2001, for school-required physical examinations for beneficiaries through age 17.

II. PROCEDURE CODE(S)

CPT Codes: 99201-99205, 99211-99215, 99382-99387, and 99392-99397

III. DESCRIPTION(S)

A.      A routine physical examination is an evaluation and management of the general health of adults and children conducted in the absence of a presenting complaint or other indication of illness or injury.

IV. POLICY

A.      A physical examination associated with well child care is covered.

B.      A school-required physical examination for beneficiaries through age 17 is covered.

C.      A physical examination is covered when performed in connection with immunizations.

D.      A physical examination is covered when performed with connection with the following cancer screenings:

1.       Cervical cancer screening, including but not limited to PAP (Papanicolaou) screening tests (see Chapter 2, Section 35.2, PAP (Papanicolaou) Tests and Chapter 2, Section 23.1A, Addendum 1 Preventive Services).

2.       Breast cancer screening, including but not limited to mammography (see Chapter 2, Section 2.1, X ray Mammography).

3.       Screening examinations for colon or prostate cancer.  (See Chapter 2, Section 23.1, Preventive Services, Chapter 2, Section 23.1A, Addendum 1 Preventive Services and Chapter 2, Section 3.5, Prostate Cancer).

E.       A physical examination for the purpose of diagnosing a medical condition is not considered a routine physical examination and is a covered benefit.

V. EXCLUSION(S)

A.      Routine physical examinations other than what is listed as covered under Policy.

B.      Physical examinations required for an immigrant visa application to the United States.

C.      Physical examinations for the purpose of employment.

D.      Physical examinations required for sports programs.

E.       An ancillary procedure in support of a routine physical examination.

*END OF POLICY*

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Glad to help! My wife and daughter use CHAMPVA, so it was not too difficult to find. I hope you are able to get this taken care of. Maybe you can use it to hopefully reverse their previous denial, if your circumstances match what is listed in the link.

Good luck!

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My wife has used her ChampVA which is tied into medicare now. If Medicare approves Champva as to pay their part.

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If nothing else, schedule with your annual flu shot, then it is covered by IV.C.  Kill two birds with one stone.

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