CHAMPVA coverage by specialty
CHAMPVA has no network and needs no referrals, but what it pays for changes by specialty. Each page below explains the rules in plain English and opens a search for that specialty in your state.
Family DoctorsFamily medicine is fully covered by CHAMPVA: annual physicals, immunizations, sick visits, and cInternal Medicine DoctorsInternists are covered by CHAMPVA for adult primary care and complex chronic conditionsPediatriciansCHAMPVA covers children of eligible veterans through age 18, or 23 in schoolNurse PractitionersNurse practitioners can bill CHAMPVA just like physiciansPhysician AssistantsPhysician assistants can bill CHAMPVA for primary, urgent, and specialty careCardiologistsCardiology is covered by CHAMPVA with no referral required: consults, echocardiograms, stress teDermatologistsCHAMPVA covers medically necessary dermatology, including skin cancer screening and treatment, bOB-GYN DoctorsCHAMPVA covers family planning, maternity care, and gynecologic care with no referralOrthopedic SurgeonsOrthopedic care is covered by CHAMPVA with no referral: fractures, joint replacement, sports injPsychiatristsCHAMPVA covers psychiatric care and medication management as outpatient care with no referralPsychologistsCHAMPVA covers outpatient therapy with clinical psychologists, no referral requiredClinical Social WorkersLicensed clinical social workers provide covered outpatient counseling under CHAMPVA with no refOptometristsCHAMPVA does not cover routine eye exams, eyeglasses, or contact lenses, but it does cover eye cOphthalmologistsMedical and surgical eye care is covered by CHAMPVA: cataract surgery, glaucoma, macular degenerPodiatristsCHAMPVA covers medically necessary podiatry such as injuries, infections, and diabetic foot careChiropractorsNot covered: see what isGeneral SurgeonsSurgery is covered by CHAMPVA, and Medicare-participating hospitals must accept itUrologistsUrology is covered by CHAMPVA with no referral, including prostate cancer screening, kidney stonNeurologistsNeurology is covered by CHAMPVA with no referral and no approval for diagnostic tests such as MRGastroenterologistsColorectal cancer screening is covered preventive care under CHAMPVA, and GI consults need no rePhysical TherapistsPhysical therapy is covered by CHAMPVA as medically necessary outpatient care, with no referral Occupational TherapistsOccupational therapy is covered by CHAMPVA when medically necessary: stroke recovery, hand theraAudiologistsCHAMPVA excludes hearing aids by federal regulation, but covers hearing care tied to a medical c
The rules that apply to every specialty
After a $50 yearly outpatient deductible per person ($100 per family), you pay 25 percent of the CHAMPVA allowable amount for covered care, and your family's yearly costs stop at $3,000. No referral is needed for any specialist. A short list of services needs preauthorization: inpatient mental health care, substance use treatment, the limited dental care CHAMPVA covers, organ and bone marrow transplants, and medical equipment priced at $2,000 or more. Details: what CHAMPVA costs and the referral and preauthorization rules.