Community Care

VA publishes Clinical Determinations and Indications (CDIs) that outline clinical criteria and parameters for services and procedures Veterans may receive in the community. CDIs were previously known as Community Care Medical Policies.

NOTE: While CDIs are intended for community providers, VA providers and staff should also use them as a clinical review tool when determining clinical appropriateness.

Referencing CDIs before providing care will increase the speed at which VA processes requests for services from community providers. It also helps ensure the care being recommended meets VA clinical criteria.

Please note that CDIs will not affect provider reimbursement for care at this time. Payment continues to be governed by existing contracts. Check this page regularly to ensure you have the most current CDI.

To access the library of published CDIs, please read and accept the end user agreement below.

End User Agreement to Access Library of Clinical Determinations and Indications

Please indicate your agreement and acceptance by selecting the button labeled "I Accept" below.

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By clicking “I Accept,” I acknowledge and accept the following:

• Clinical Determinations and Indications are intended to be reference material for non-VA providers and do not guarantee benefits or constitute medical advice. The treating clinician is solely responsible for provision of medical advice and the treatment of the Veteran. Veterans should review CDIs with their local Veterans Affairs Medical Center (VAMC) to discuss coverage determinations.
• Clinical Determinations and Indications express VA’s determination of whether certain services or treatments are medically necessary and appropriate. The CDIs are in accordance with 38 C.F.R. (Code of Federal Regulations) §17.38 (b) and (c)(3) based on the comprehensive analysis of current evidence-based resources, which may include the following:
  • Peer-reviewed literature from academic medical journals
  • Clinical practice guidelines from national health professional organizations
  • Guidance from VA and Department of Defense (DoD) resources
  • Guidance from U.S. regulatory entities (Food and Drug Administration, Centers for Medicare and Medicaid Services, federal and state mandates)
  • Evidence-based guidelines of public health and health research agencies
  • Clinical expertise and judgment of VA physicians from the national program offices
• The VA medical benefits package is not a health insurance plan. It is a benefit grounded in statute and regulation.

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