Vet & Family Member Program

Veteran and Family Member Program - CHAMPVA

The VFMP Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), is for individuals who are either the spouse or children of a disabled Veteran, or the surviving spouse or child of a Veteran who has died AND do not qualify for TRICARE.
The Department of Veterans Affairs (VA) VFMP - CHAMPVA mobile application (app) is designed for medical service providers (VA and private practice) and beneficiaries as they plan care and medical procedures. Beneficiaries and providers use the app individually, or together during a patient encounter, to determine whether the VA will pay for care delivery.
The VFMP - CHAMPVA app uses several different medical code sets to determine if services and/or equipment are covered. Over 487,000 individual medical codes are listed in the included databases. Medical code sets include:
American Dental Association (ADA) codes, which describe dental services. ADA coding identifies services rendered.
Current Procedural Terminology (CPT) codes, which describe medical, surgical, and diagnostic services. CPT coding identifies services rendered.
ICD-10 codes, which relate to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. The CHAMPVA app uses ICD-10-CM data from the Centers for Medicare and Medicaid Services (CMS).
The Healthcare Common Procedure Coding System (HCPCS) codes, which provide a standardized coding system for describing the specific items and services provided in the delivery of health care. Such coding is necessary for CHAMPVA, Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner.
Durable Medical Equipment (DME) codes refer to equipment that can withstand repeated use, is primarily used to serve a medical purpose, is generally not useful in the absence of an illness or injury and is appropriate for use in the home. DME codes are included with HCPCS Codes.
The national drug codes (NDC) are unique 10-digit, three segment numerical codes that identify drugs intended for human use. The first segment is a 4 to 5 digit, Food and Drug Administration (FDA) assigned labeler code to identify the firm that